BESOUW, MARTINE

Dossche, Lien

Raes, Ann

English

Ghent University Academic Bibliography

Recurrent hematuria due to nutcracker syndrome: Imaging techniquesDOSSCHE  L.1, , RAES A.1,, BESOUW M.11Department of Paediatric Nephrology, Ghent University Hospital, Ghent, BelgiumCase Reports Recurrent hematuria in children without UTI is mainly explained by a glomerulopathy, hypercalciuria/nephrolithiasis, Alport syndrome ornutcracker syndrome. The latter results from compression of the left renal vein between the superior mesenteric artery and the aorta (Fig.1)Clinical presentation of nutcracker syndrome can vary from asymptomatic hematuria to severe abdominal pain. Mild proteinuria can beassociated. Left renal venography is considered to be the gold standard, but is invasive. Doppler ultrasonography can be used as firstdiagnostic test. However, two cases are presented where nutcracker syndrome was diagnosed with MRA, while Doppler ultrasound showed noabnormalities.IntroductionCASE 1:A 16 years old boy presented with 2 identical episodes of macroscopichematuria with mild flank pain after viral infection. Symptomsdisappeared after 3 days. Inter-episode urine samples showedFig. 2: Doppler ultrasonography showed  no decreased diameter of the left renal vein and normal bloodflow rate  .microscopic hematuria and discrete proteinuria. On Dopplerultrasonography there were no arguments for nutcracker syndrome(Fig. 2) However, MRA revealed compression of the left renal veinbetween the aorta and superior mesenteric artery (Fig. 3)CASE 2:A 7 years old boy presented with a second episode of macroscopichematuria (without proteinuria) since 1 day. The first episode occurredat the age of 3 years and disappeared after 2 days. Both episodes wereidentical, with no clinical symptoms besides mild abdominal pain. Inboth cases the diagnostic work-up for hematuria was performed.Laboratory blood investigations and 24-hour urine collection werewithin normal ranges. Renal ultrasonography showed nonephrolithiasis. Doppler ultrasonography showed no signs of renalvein compression. MRA did show left renal vein entrapment.DiscussionDoppler ultrasonography can be used as first diagnostic test for renal vein entrapment,but has a limited sensitivity, especially in children.MRA findings are similar to CT and avoid radiation. In case of recurrent hematuria, a nutcracker syndrome should be excluded beforeperforming a renal biopsy, which is an invasive procedure. Expectation management is appropriate in the great majority of children withconfirmed nutcracker syndrome.CONTACT: lien.dossche@ugent.beDepartment of Paediatric Nephrology, Ghent University Hospital, Ghent, BelgiumConclusion:Nutcracker syndrome is a rare cause of recurrent hematuria in children but should always beconsidered, even when Doppler ultrasonographic assessment shows NO anomalies.By performing a MRA-scan, unnecessary renal biopsies can be avoided in these patients.Fig. 3: MRA revealed a dilated left renal vein with compression between the aorta and superior mesenteric artery   Fig. 1: compression of the left renal vein between the superior mesenteric artery and the aorta (Source: http://dx.doi.org/10.1016/j.jvs.2008.09.051)

Recurrent hematuria due to nutcrackers syndrome: imaging techniques

https://biblio.ugent.be/publication/7150436/file/7150487.pdf

Recurrent hematuria due to nutcrackers syndrome: imaging techniques

Abstract

Similar works

Full text

Available Versions

Ghent University Academic Bibliography