Abstract
The Authors Reply: We read with interest the letter ‘Low body mass index in nutcracker phenomenon: an underrecognized condition’ by Drs Park and Shin,1Park S.J. Shin J.I. Low body mass index in nutcracker phenomenon: an underrecognized condition.Kidney Int. 2013; 84: 1287Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar who were writing about the prior article ‘Physical finding of nutcracker phenomenon’ by Dr Matsubara et al.2Matsubara T. Ogawa O. Yanagita M. Physical finding of nutcracker phenomenon.Kidney Int. 2013; 83: 335Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar Both articles are related to our recent study, which showed appreciable proteinuria in individuals with a low body mass index (BMI)3Muneyuki T. Sugawara H. Suwa K. et al.A community-based cross-sectional and longitudinal study uncovered asymptomatic proteinuria in Japanese adults with low body weight.Kidney Int. 2013; 84: 1254-1261Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar because the nutcracker phenomenon (NP) is characterized by proteinuria, hematuria, and anemia.4Kurklinsky A.K. Rooke T.W. Nutcracker phenomenon and nutcracker syndrome.Mayo Clin Proc. 2010; 85: 552-559Abstract Full Text Full Text PDF PubMed Scopus (294) Google Scholar Readers may wonder whether proteinuria in subjects with low BMI (≤18.9kg/m2) is partially due to the NP. In our original report, we did not assess the relationships between the prevalence of hematuria determined by dipstick analysis (n=6031) and the circulating hemoglobin level and BMI. Reanalysis of the data showed that hematuria (≥ +1) was infrequent in males and females with low BMI (Figure 1a). The circulating hemoglobin was higher in subjects with proteinuria than in those without, irrespective of BMI (Figure 1b). Multivariate logistic regression analysis showed that hematuria was not associated with low BMI compared with the reference BMI (21.0–22.9kg/m2) (odds ratio: 1.22; 95% confidence interval: 0.75–1.97; P=0.42; data not shown) after adjusting for the confounders used in our prior report.3Muneyuki T. Sugawara H. Suwa K. et al.A community-based cross-sectional and longitudinal study uncovered asymptomatic proteinuria in Japanese adults with low body weight.Kidney Int. 2013; 84: 1254-1261Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar Thus, although proteinuria due to the NP should not be ignored in young lean people, proteinuria in low BMI subjects is unlikely to be due to the NP, at least in our original report.
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