Abstract
Nutcracker phenomenon (NCP) is caused by a compression of left renal vein between aorta and superior mesenteric artery. The traditional clinical manifestations of nutcracker syndrome is usually accompanied with abdominal pain, hematuria, orthostatic proteinuria, and varicocele formation, however, hypertension is rarely reported as main clinical feature. We describe a male adolescent with manifestation of hypertension who was identified as NCP. Renal ultrasound and computed tomography angiography have provided evidences of left renal vein dilatation, probably due to the compression through the decreased angle between aorta and superior mesenteric artery. There were no other signs for secondary hypertension for the blood levels of renin and aldosterone being between normal limits and urinalysis being negative of hematuria and proteinuria. This patient was conservatively observed without any anti-hypertensive drugs and was asked for appropriately putting on weight. Three months later, the hypertension symptom was alleviated. In conclusion, although there were no established direct pathogenetic links between hypertension and NCP, no other definite etiology was shown to be the cause of this main manifestation. Thus we speculate that the NCP might be the main cause of hypertension in this patient.
Highlights
Nutcracker phenomenon (NCP), known as left renal vein entrapment, is characterized by impeded outflow from the left renal vein (LRV) into the inferior vena cava due to extrinsic LRV compression, often accompanied by demonstrable lateral dilatation and medial narrowing
The traditional clinical manifestations of nutcracker syndrome is usually accompanied with abdominal pain, hematuria, orthostatic proteinuria, and varicocele formation, hypertension is rarely reported as main clinical feature
We describe a male adolescent with manifestation of hypertension who was identified as NCP
Summary
Nutcracker phenomenon (NCP), known as left renal vein entrapment, is characterized by impeded outflow from the left renal vein (LRV) into the inferior vena cava due to extrinsic LRV compression, often accompanied by demonstrable lateral (hilar) dilatation and medial (mesoaortic) narrowing. The nutcracker syndrome (NCS) is the clinical equivalent of NCP characterized by a complex of symptoms with substantial variations, which is called “renal vein entrapment syndrome” [1]. These anatomical findings were first described by Schepper in 1972 [2], who first proposed the term “nutcracker”, and first elaborated the pathophysiologic process of renal hemorrhage caused by this phenomenon. NCP is a rare clinical condition that more occurs relatively in adolescents or young adults and previously healthy patients It is characterized usually by mild hematuria, orthostatic proteinuria, mild anemia and chronic fatigue, left flank pain, left-sided varicocele in males and pelvic congestion in females [3]. We describe a young male with hypertension caused by NCP, which probably is the rarest cause of hypertension
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