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World Journal of Nephrology and Urology, ISSN 1927-1239 print, 1927-1247 online
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Letter to the Editor

                                                                                       

Volume 1, Number 2-3, June 2012, page 98

 

Entrapment of the Left Renal Vein: A Rare Cause of Proteinuria


Sik Leea, c, Young Min Honga, Kyung Pyo Kanga, Won Kima, Sung Kwang Parka, Jong Kwan Parkb


 

aDepartment of Internal Medicine, Renal Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea

bDepartment of Urology, Renal Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea

cCorresponding author: Sik Lee, Department of Internal Medicine, Chonbuk National University Medical School, 634-18, Keum-Am Dong, Jeonju, 561-712, Republic of Korea. Email: kidney@jbnu.ac.kr

 

Manuscript accepted for publication June11, 2012

Short title: Entrapment of the Left Renal Vein

doi:10.4021/wjnu28w

 

To the Editor:  

A 26-year-old man visited our institution for evaluation of proteinuria. He intermittently presented with acute urinary retention. Other urological evaluations were unremarkable. Urinalysis exhibited trace proteins without hematuria. Renal duplex and enhanced computed tomography (CT) of the abdomen and pelvis were performed. The duplex ultrasound typically demonstrated aortomesenteric anatomy with entrapment of the left renal vein (LRV) (Fig. 1). The diameters of the LRV at the hilar and aortomesenteric portions were measaured as 11 mm and 1.2 mm, respectively. The duplex ultrasound also indicated a significantly higher ratio of the peak systolic velocity (PSV) to the hilar renal vein PSV at the point of renal vein compression (> 6). This observation demonstrates the diminished volume of flow and dampened pulsatility upon spectral analysis of the left renal vein. Enhanced CT angiography revealed compression of the left renal vein between the aorta and the superior mesenteric artery (Fig. 2). The Nutcracker syndrome is defined as a rare cause of hematuria and flank pain caused by compression of the left renal vein between the aorta and the superior mesenteric artery where it passes at the point of bifurcation of the arteries [1]. The observed compression causes venous hypertension and the formation of renal venous collaterals leading to the subsequent rupture of the septum between the veins and the collecting system, and finally, resulting in hematuria and flank pain [2, 3]. In this particular patient case, although rare, the nutcracker should be included as the potential cause of proteinuria in addition to hematuria in the absence of other renal diseases.

 


Figure 1.
The duplex ultrasound typically demonstrated aortomesenteric anatomy with entrapment of the left renal vein (LRV).

 


Figure 2.
Enhanced CT angiography revealed compression of the left renal vein between the aorta and the superior mesenteric artery.

 

 

References

 

1. Jang YB, Kang KP, Lee S, Kim W, Kwak HS, Park SK. Posterior nutcracker phenomenon. Nephrol Dial Transplant. 2005;20(11):2573-2574.
[Medline]
[CrossRef]
2. Pytel A. Renal fornical hemorrhages: their pathogenesis and treatment. J Urol. 1960;83:783-789.
[Medline]
3. Rudloff U, Holmes RJ, Prem JT, Faust GR, Moldwin R, Siegel D. Mesoaortic compression of the left renal vein (nutcracker syndrome): case reports and review of the literature. Ann Vasc Surg. 2006;20(1):120-129.
[Medline]
[CrossRef]

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Digital Object Identifier (DOI):10.4021/wjnu28w
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World Journal of Nephrology and Urology, quarterly, ISSN 1927-1239 (print), 1927-1247 (online), published by Elmer Press Inc.     
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