Left Renal Venous Hypertension Research Articles

Bovine Pericardial Tube as a Conduit for Left Renal Vein Transposition in Treatment of Nutcracker Syndrome

Abstract Nutcracker syndrome (NCS) is caused by compression of the left renal vein (LRV) between the aorta and the superior mesenteric artery. This results in left renal venous hypertension and the subsequent development of venous varicosities of the renal pelvis, ureter, and gonadal vein, also called renal vein entrapment syndrome. Its treatment includes open surgical technique as well as minimally invasive technique, namely laparoscopic and endovascular techniques. Here, we report the case of a young male diagnosed with NCS treated with LRV transposition using bovine pericardium as conduit interposing between inferior vena cava and LRV.

Anterior Nutcracker syndrome as a rare cause of hematuria in an 8 year old boy: A case report

Nutcracker syndrome is caused by a compression of the left renal vein between the aorta and the superior mesenteric artery. It results in left renal venous hypertension, and the subsequent development of venous varicosities of the renal pelvis, ureter, and gonadal vein. We report a rare case in an 8-year-old boy who presented with a history of intermittent episodes of hematuria leading to anemia and left flank pain. Ultrasound examination of abdomen revealed bulky left kidney and features of subacute medical renal disease. Computed tomography of abdomen showed compressed left renal vein between aorta and superior mesenteric artery. Authors report the successful operative management of this rare syndrome in a pediatric patient.

Nutcracker syndrome manifesting with severe proteinuria: a challenging scenario in a single-kidney patient

Nutcracker syndrome (NS) refers to compression of the left renal vein between the aorta and the superior mesenteric artery which results in left renal venous hypertension. The typical clinical presenting feature is hematuria. In this report we describe the case of patient with a single kidney who developed severe proteinuria due to NS. She was successfully treated with left renal vein transposition. This case clearly shows the relation between NS and severe proteinuria based on normal biopsy findings and the complete disappearance of proteinuria following surgery.

Management of renal nutcracker syndrome by retroperitoneal laparoscopic nephrectomy with ex vivo autograft repair and autotransplantation: a case report and review of the literature

IntroductionNutcracker syndrome (NCS) is caused by a compression of the left renal vein between the aorta and the superior mesenteric artery (SMA). It results in left renal venous hypertension, and the subsequent development of venous varicosities of the renal pelvis, ureter, and gonadal vein.Case presentationA 21-year-old Chinese woman was admitted with a seven-month history of unilateral severe hematuria. On admission, she was identified as having nutcracker syndrome. The patient was treated with retroperitoneal laparoscopic donor nephrectomy and renal autotransplantation. The patient underwent retroperitoneal laparoscopic donor nephrectomy using a retroperitoneal three-port technique with ex vitro autograft repair and subsequent renal autotransplantation into the iliac fossa. In order to shorten the hot ischemia time and improve the patient's cosmetic outcome, a minor oblique incision in the left, lower quadrant was prepared in advance of the laparoscopic donor nephrectomy for use as a site for the autograft to be procured through the retroperitoneal space and as a transplant site for the autograft. Two days after the operation, the patient's symptoms subsided. Serum creatinine before and after the operation were 53 mmol/L and 55 mmol/L, respectively. The patient had normal renal function during a follow-up three months after the operation.ConclusionThe treatment of nutcracker syndrome by retroperitoneal laparoscopic nephrectomy with ex vitro repair and autotransplantation is a simpler and less invasive procedure than open surgery. Moreover, a minor incision on the left hypogastrium can shorten the autograft's hot ischemic time and improve patients' cosmetic outcomes, especially in young women.

Actitud expectante en el síndrome del cascanueces

Nutcracker syndrome is caused by compression of the left renal vein between the aorta and the superior mesenteric artery where it passes in the fork formed at the bifurcation of these arteries. The phenomenon results in left renal venous hypertension. The syndrome is manifested by left flank and abdominal pain, with or without unilateral haematuria. The nutcracker syndrome has been treated in various ways. We report one case of the syndrome and discuss the place of surveillance in its management.

Comment on Gastrointestinal Symptoms Associated with Orthostatic Intolerance

Dear Editor, We read with interest the article by Sullivan et al. (1) entitled "Gastrointestinal Symptoms Associated with Orthostatic Intolerance." In this context, it is noteworthy that several studies have provided evidence of an association between orthostatic intolerance and the "nutcracker syndrome." Hilgard et al. (2) reported that the coexistence of this syndrome with severe gastrointestinal symptoms and paroxysmal tachycardia may be caused by congestion of the splanchnic veins consequent to obstruction of the left renal vein. Takemura et al. (3) reported 4 adolescents who complained of physical discomfort, including headache, abdominal pain, fainting and tachycardia thereby mimicking the clinical symptoms of an orthostatic disturbance, which resulted in absence from school. Three patients were found to have nutcracker syndrome, and Takemura et al postulated that a decreased venous blood flow back to the heart, caused by congestion of blood in the left renal vein, might have caused the tachycardia and palpitations in these patients. Takahashi et al. (4) also described 9 children with orthostatic dysregulation who were intermittently or persistently absent from school. Also, the patients complained of various combinations of symptoms, such as chronic fatigue, headache, lightheadedness, dizziness, abdominal pain, unrefreshing sleep, muscle pain, joint pain, sore throat, low-grade fever, afebrile chills in hot summer and depression, which were compatible with the criteria of a disease entity of chronic fatigue syndrome or idiopathic chronic fatigue. Takahashi et al. speculated that severe congestion in the adrenal medulla caused by left renal venous hypertension might derange a complex set of central neural connections that controls the sympathoadrenal system. Alternatively, they suggested that overproduction or night retention of catecholamines might be responsible for these symptoms. Takahashi et al. (5) reported the case of 13-year-old girl who had been monitored because of a school phobia associated with orthostatic hypotension, tachycardia and chronic fatigue syndrome. This patient was successfully treated with transluminal balloon angioplasty of the compressed left renal vein between the aorta and superior mesenteric artery. Chronic fatigue syndrome and autonomic dysfunction symptoms also improved after catheter manipulation, which suggests that there could be a link between nutcracker syndrome and these autonomic symptoms. In conclusion, orthostatic intolerance appears to be closely related with nutcracker syndrome. Further studies are necessary to elucidate the prevalence and hemodynamic or neuroendocrine effects of nutcracker syndrome in children with orthostatic intolerance and abdominal pain. Jae Il Shin, MD Jae Seung Lee, MD The Institute of Kidney Disease Department of Pediatrics Yonsei University College of Medicine Severance Hospital Seoul, Korea

Síndrome del cascanueces. a propósito de un caso y revisión de la literatura

Nutcracker syndrome is caused by compression of left renal vein between the aorta and the superior mesenteric artery. This phenomenon results in left renal venous hypertension, left gonadal vein varices and unilateral hematuria. We report a typical case of nutcracker syndrome and we review the literature in an effort to explain this pathology.

Left renal venous hypertension “nutcracker” syndrome: Managed by Direct Renocaval Reimplantation

Since 1978 a diagnosis of left renal venous hypertension has been established in 3 patients. All 3 had otherwise unexplained left flank and abdominal pain, 2 had left renal gross hematuria, and 2 were found to have ureteral and peripelvic varices demonstrated by selective renal venography. All were found to have mild to moderate pressure gradients between the left renal vein and vena cava, presumably due to compression of the left renal vein between the aorta and overlying superior mesenteric artery. Direct left renocaval reimplantation was performed in all cases, with resection of the collateral varices that were present in 2 cases. Severe unrelenting pain was the primary indication for surgery in all cases, rather than hematuria. All remain asymptomatic one to four years after surgery.