Obstruction Of Left Renal Vein Research Articles

Orthostatic proteinuria due to inferior vena cava interruption without nutcracker phenomenon in an old obese female: a case report and literature review

BackgroundNutcracker syndrome (NCS) caused by left renal vein (LRV) entrapment, is one of the most common causes of orthostatic proteinuria. In stereotype, orthostatic proteinuria is often accompanied by left renal vein obstruction and is found in young and underweight individuals. Here, we report a rare case with orthostatic proteinuria in an old obese female caused by a rare type of congenital inferior vena cava (IVC) interruption.Case presentationA 65-year-old obese woman, who suffered from fluctuated proteinuria, had been misdiagnosed as chronic glomerulitis for 30 years. Instead of having any sign of NCS, she had a unique type of IVC interruption. Most venous blood from infrarenal IVC and right kidney drained into her LRV, and then through the expanded communicating vessel, drained into the left ascending lumbar vein which extended as hemiazygos vein. To the best of our knowledge, this is one of the first cases reported of orthostatic proteinuria attributed to the subsequent hemodynamic irregularity caused by IVC interruption without nutcracker phenomenon.ConclusionAdult-onset orthostatic proteinuria is relatively rare, hard to be recognized and could be misdiagnosed as chronic glomerulonephritis. The case provided a novel differential diagnostic condition for those who suffered from fluctuated proteinuria of unknown causes.

Renal congestion associated with left renal vein obstruction. A nephrology picture.

Renal congestion associated with left renal vein obstruction. A nephrology picture.

A CURIOUS CASE OF URINOTHORAX

TOPIC: Disorders of the Pleura TYPE: Medical Student/Resident Case Reports INTRODUCTION: Urinothorax (UT), is a rare cause of pleural effusion caused by accumulation of urine in the pleural space. It is usually the result of trauma or obstruction of the urinary tract. We present a case of a tension UT developed due to accidental displacement of a ureteral stent. CASE PRESENTATION: 80-year-old male with medical history significant for chronic kidney disease stage III, nephrolithiasis, prostate cancer status post prostatectomy and hospitalizations for obstructive uropathy requiring ureteral stent placement presented with progressively worsening dyspnea and acute encephalopathy. He was hypotensive and hypoxic requiring admission to the intensive care unit. Of note, patient was discharged 2 days ago after exchange of double J ureteral stent and removal of nephrostomy tube. Physical examination revealed a confused elderly male in respiratory distress. Patient had absent breath sounds and dullness on percussion of the right chest. Laboratory investigations were consistent with acute kidney injury. His imaging showed complete opacification of right hemithorax, consistent with large right sided pleural effusion and mediastinal shift to the left. Commuted tomography (CT) of the chest showed proximal aspect of the ureteral stent had migrated into the right pleural space. A chest tube was placed with drainage of yellow colored fluid and resolution of hypotension and hypoxia. On analysis, pleural fluid was transudative in nature with creatinine of 10.5 mg/dl. The findings of pleural fluid analysis including serum creatinine ratio greater than 1 and imaging confirmed the diagnosis of UT. The chest tube was kept in place for the drainage of urinoma and J-stent was removed under general anesthesia with repeat imaging showing resolution of the pleural effusion. DISCUSSION: UT usually presents as unilateral or bilateral pleural effusion usually due to trauma or obstruction of urinary tract. It has a male predominance and can occur at any age. Traumatic etiologies including surgical injuries, blunt trauma, medical procedures etc. are common causes of UT. Less commonly, UT can be due to obstructive causes due to prostate disease, left renal vein obstruction etc. Patients usually present with symptoms of flank pain, shortness of breath, or decreased urine output. Diagnosis is made on pleural fluid analysis with pleural fluid to serum creatinine ratio greater than 1 with associated obstructive or traumatic uropathy. Treatment of UT is by draining the pleural fluid and correcting the underlying etiology. To our knowledge, this is the first case reported of urinothorax secondary to ureteral stent displacement into the pleural space. CONCLUSIONS: UT is a rare but curable cause of pleural effusion. Though there is paucity of data, however, according to the reported causes patients have favorable prognosis if diagnosed early. REFERENCE #1: Toubes ME, Lama A, Ferreiro L, Golpe A, Álvarez-Dobaño JM, González-Barcala FJ, San José E, Rodríguez-Núñez N, Rábade C, Lourido T, Valdés L. Urinothorax: a systematic review. Journal of thoracic disease. 2017 May;9(5):1209. REFERENCE #2: Garcia-Pachon E, Romero S. Urinothorax: a new approach. Current opinion in pulmonary medicine. 2006 Jul 1;12(4):259-63. REFERENCE #3: Stark DD, Shanes JG, Baron RL, Koch DD. Biochemical features of urinothorax. Archives of internal medicine. 1982 Aug 1;142(8):1509-11. DISCLOSURES: No relevant relationships by Dheera Grover, source=Web Response No relevant relationships by Prashant Grover, source=Web Response No relevant relationships by Simrina Sabharwal, source=Web Response

Posture commonly and considerably modifies stenosis of left common iliac and left renal veins in women diagnosed with pelvic venous disorder

ObjectivePelvic venous incompetence or pelvic congestion syndrome (commonly referred to as pelvic venous disorder [PVD]) is increasingly diagnosed, especially in multiparous women. This may be either primary or secondary to pelvic venous outflow obstruction—left common iliac vein (LCIV) or left renal vein (LRV) stenosis. Intravascular ultrasound (IVUS) examination performed in the supine position is commonly used for diagnosis of LRV and LCIV stenosis; however, body position may affect the cross-sectional area (CSA) of both of these veins during IVUS. The aim of the study was to test the hypothesis that postural changes may significantly affect the CSA of the LRV and LCIV. MethodsA single-arm, single-center cohort study of women suffering from PVD was performed at a tertiary hospital in Poland. It comprised consecutive patients with either pelvic vein reflux or suggestion of LCIV or LRV obstruction but no signs of deep venous thrombosis. IVUS examination of the iliac veins, inferior vena cava, and LRV was performed in the supine position. IVUS of the LRV and LCIV was performed also with a Valsalva maneuver and with patients lying on the left side and standing. A 60% CSA reduction was used as a cutoff value between significant and nonsignificant vein stenosis. ResultsA total of 41 women were examined. Significant stenosis of the LRV was seen in 22 patients (55%) supine but in only 4 (10%) patients studied when lying on the left side and in 27 (67.5%) patients studied while standing. Significant stenosis of the LCIV was seen in 26 supine patients (63.4%), in 8 lying on the left side (19.5%), and in 10 (24.4%) standing. ConclusionsPostural changes dramatically affect CSA of the LCIV and LRV and thus the degree of stenosis in women diagnosed with PVD. Stenosis found in patients while supine often disappears when the position is changed to lying on the left side or to standing. Therapeutic decisions based on assessment of CSA reduction in the supine position are likely to be inadequate.

Hemodynamic Consequences of Deep Venous Obstructive Disease.

Hemodynamic Consequences of Deep Venous Obstructive Disease.

Nonthrombotic Venous Obstructions Cause Pelvic Congestion Syndrome.

Pelvic congestion syndrome (PCS) usually is attributed to ovarian or internal iliac vein reflux. Until recently, nonthrombotic iliac vein obstruction and left renal vein obstruction rarely have been reported as causes of PCS.

Randomized Double-Blinded Study Comparing Clinical Versus Endovascular Treatment of Iliac Vein Obstruction.

Randomized Double-Blinded Study Comparing Clinical Versus Endovascular Treatment of Iliac Vein Obstruction.

Renal Vein Thrombosis and Membranous Nephropathy - Report of 2 Cases

Patients with nephrotic syndrome presents a high risk of arterial and venous thrombosis, mainly deep vein thrombosis and renal vein thrombosis (RVT). We describe two cases of patients with diagnosis of membranous nephropathy and RVT. The first patient was 32 years, male, and admitted with nephrotic syndrome. Laboratory tests showed urea 16mg/dL, creatinine 0.9mg/dL; proteinuria 17g/day. Abdominal ultrasound evidenced obstruction of right and left renal veins and left inferior vena cava. Renal biopsy was compatible with membranous nephropathy. The second patient, a 27 years old male was admitted with nephritic syndrome. Laboratory tests at admission showed urea 25mg/dL; creatinine 1.1mg/dL; 24h proteinuria 3.86g, abdominal ultrasound showed endoluminal obstruction of left renal vein and increased size left kidney. Renal biopsy showed membranous nephropathy. RVT is not common in patients with nephrotic syndrome, and it is more frequent in membranous nephropathy. Treatment includes intravenous anticoagulant followed by oral drugs. Prophylaxis in nephritic patients is controversial. Keyword: Nephrotic syndrome; Thrombosis; Membranous glomerulonephritis; Blood coagulation DOI: 10.3329/jom.v12i1.5919J Medicine 2011; 12 : 73-76

The Changes of Testis and the Effects of Anthocyanin on Spermatogenesis in Rat Induced Varicocele

Purpose: Varicocele is known as a main cause of primary male infertility and it supposed to be associated with oxidative stress. Anthocyanin is known as a natural plant pigment and novel antioxidant. This study was designed to investigate the effects of anthocyanin on a rat model of varicocele. Materials and Methods: Twenty four male rats, induced varicocele by partial obstruction of left renal vein, were divided into four experimental groups: the group induced varicocele for four weeks without anthocyanin, the group received anthocyanin (80 mg/kg) right after varicocele induction, group induced varicocele for eight weeks without anthocyanin, and the group received anthocyanin (80 mg/kg) after four weeks observation following varicocele induction. After anthocyanin treatment, testes from the rats in all groups were removed, weighed, and subjected to histological examination. Apoptosis in the testes was measured by the TUNEL assay. And the oxidative stress was evaluated by measurement of 8-hydroxy-2'-deoxyguanosine (8-OHdG). Results: Induction of varicocele led to decreasing left testis weight, decreasing spermatogenic cell density significantly (p <0.05). Also it led to increasing apoptotic body counts and increasing concentration of 8-OHdG significantly (p<0.05). However administration of anthocyanin right after varicocele induction prevent this change meaningfully (p<0.05). In group received anthocyanin after four weeks observation following varicocele induction, interestingly, there was no significant difference in testis weight, spermatogenic cell density, apoptotic body count and concentration of 8-OHdG compared to group induced varicocele for eight weeks without anthocyanin administration. Conclusions: These results suggest that anthocyanin is effective in decreasing the oxidative stress of testis in rat induced varicocele and may be effective in making a healthy sperm in patient of varicocele in early stage. However in patient under way in advanced stage, it is supposed that the anthocyanin cannot help having a protective effect from oxidative stress narrowly unless the condition of oxidative stress by varicocele is corrected. Further studies are needed to better understand the mechanisms and actions of anthocyanin and varicocele, and these studies may lead

The effects of varicocele and its surgical correction on vas deferens motility

Varicocele is the abnormal dilation of venous pampiniform plexus and internal spermatic vein. Its prevalence in the adolescent period is almost equal to the prevalence of adult age. That is why the disease is accepted to appear in early adolescence and does not disappear spontaneously. Varicocele is established to be the most common cause of infertility in the adulthood period in terms of the testicular and/or epididymal damages it causes. Besides, malfunctioning of testis and/or epididymis cannot be blamed as the one and only reason of infertility. One major reason of the male infertility is vas deferens motility disorders. There is limited data in the literature investigating the effects of varicocele on the vas deferens motility. The aim of the study is to evaluate not only the motility defects of vas deferens for the period of varicocele, but also the effects of surgical varicocele correction on vas deferens motility. Thirty male Wistar-Albino rats were allocated to five groups. In the control group (Gr C, n = 6) bilateral vas deferens strips were harvested without any surgical intervention. Using the partial left renal vein obstruction technique, the experimental varicocele model was performed for the other four groups. Varicocele was apparent for these animals after the fourth week of the venous ligation. Bilateral vas deferens strips of varicocele group (Gr V, n = 6) were harvested. The rest of the animals having varicocele underwent relaparotomies. Three different surgical procedures were performed to these animals. The animals of group P (Gr P, n = 6) and group I (Gr I, n = 6) underwent Palomo and Ivanissevich procedures, respectively, for varicocele correction. And the animals of group S (Gr S, n = 6) underwent sham operation. After 4 weeks of relaparotomies, bilateral vas deferens strips of all three groups harvested. The electrical field stimulation (EFS) induced responses of all vas deferens strips as well as exogenous drug induced responses were recorded and analysed. The results of the study showed that the varicocele significantly inhibited the first phase of biphasic response of vas deferens in the ipsilateral side. However the correction of varicocele, free from surgical technique, ameliorated the affected first phase of EFS induced biphasic response in the ipsilateral side. The results of this study suggest that varicocele can be the reason of male infertility by not only causing testicular and/or epididymal damages but also triggering vas deferens motility defects. The correction of varicocele free from surgical technique may reverse the damaging of the vas deferens. Therefore when indicated surgical correction of varicocele is essential. It seems that varicocele surgery does not only prevent late term testicular and/or epididymal damages but also avoids vas deferens motility defects.

Reversible Left Renal Vein Obstruction Caused by an Abdominal Aortic Aneurysm

The authors document a unique cause for left renal vein hypertension and hematuria in a 66-year-old woman presenting with abdominal pain, pulsatile mass, and hematuria. A computer tomographic scan of the abdomen revealed, in association with a 5.3-cm fusiform abdominal aortic aneurysm, a compressed left renal vein as well as dilatation of the left gonadal vein and the pelvic venous plexus. Arteriography confirmed functional occlusion of the left renal vein by the juxtarenal enlargement of the abdominal aortic aneurysm. This created centrifugal flow to the inferior vena cava through the left gonadal vein, the pelvic venous plexus, and the hypogastric veins. The patient underwent abdominal aortic aneurysm repair with complete recovery. A postoperative abdominal computer tomographic scan confirmed restored patency of the left renal vein and normalization of centripetal venous flow on the left side. While a number of mechanisms of renal vein obstruction have been reported, collateralization and hematuria secondary to stretching and compression of the left renal vein by an aortic aneurysm have not previously been described. Although left renal vein hypertension and hematuria are rarely associated with an aortic aneurysm, it should be recognized that a juxtarenal aneurysm may cause this syndrome.

Left renal vein “nut-cracker” phenomenon

A case of left renal vein obstruction is presented. It resulted from abnormal extrinsic pressure by the superior mesenteric artery against the aorta. Diagnostic methods and treatment are discussed.

Left renal vein obstruction associated with nonrenal malignancy: Detection by computed tomography and ultrasonography

Left renal vein (LRV) obstruction may result from retroperitoneal spread of nonrenal malignancy. Whereas, heretofore, renal venography has been necessary to confirm such an obstruction, computed tomography (CT) and ultrasonography (US) are presently the noninvasive imaging modalities of choice to substantiate the diagnosis. In 7 patients with LRV obstruction associated with carcinoma of the pancreas or lung or lymphoma, excretory urography (EU) demonstrated slight enlargement of the left kidney with attenuation of its pyelocalyceal system. Two patients showed ureteral notching. CT, performed in 6 patients, revealed retroperitoneal mass adjacent to the LRV in 5 and LRV dilatation in 3. Small round or tubular densities representing collateral veins were visualized medial to the left kidney in 3 patients. US, performed in 3 patients, revealed a generalized increase in renal parenchymal echogenicity, a mass adjacent to the LRV in 2 and an LRV clot in 1.

Experimental production of varicocele and its effect on testes.

Parital obstruction of left renal vein leads to production of varicocele in a fairly short period, i.e.; even within a month. Collateral venous channels play an important role in the formation and degree of varicocele. Varicocele has got a depressive effect on the spermatogenesis on the side of varicocele as well as on opposite testes. Leydig cells and interstitial tissue flourish at the expense of gonadal elements. The factors affecting the spermatogenesis are different from those of other tissues of the testes.