ESPN 50th Annual Meeting

ESPN 2017


 
An unusual cause of macroscopic hematuria: anterior - posterior nutcracker syndrome and left renal vein duplication
DEMET ALAYGUT 1 EREN SOYALTIN 1 CANER ALPARSLAN 1 HILAL ŞAHIN 2 SECIL ARSLANSOYU ÇAMLAR 1 FATMA MUTLUBAS 1 BELDE KASAP DEMIR 3 ÖNDER YAVASCAN 1

1- IZMIR TEPECIK TRAINING AND RESEARCH HOSPITAL, PEDIATRIC NEPHROLOGY CLINIC, IZMIR , TURKEY
2- IZMIR TEPECIK TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF RADIOLOGY, IZMIR, TURKEY
3- IZMIR KATIP CELEBI UNIVERSITY, DEPARTMENT OF PEDIATRIC NEPHROLOG, IZMIR, TURKEY
 
Introduction:

 Nutcracker syndrome (NCS) is a rare reason of hematuria. It has two anatomical appearances as anterior and posterior. Here, anterior-posterior NCS and left renal vein duplication (LRV) in a 15-year-old adolescent who applied due to complaint of macroscopic hematuria was reported.

Material and methods:

 Case :  A 15-year-old female patient applied with the complaint of red colored urination for the last 2 days. There was no macroscopic hematuria at the time of application. She had no pain, urinary burning, high fever or vomiting accompanied with this complaint.  No trauma was specified. Physical examination was normal. In the urinary examination, density was 1010, ph was 5.0, and erythrocyte was +2 positive and in her microscopic examination there were 15-20 erythrocytes in every area. There was no proteinuria. Urinary calcium creatinine ratio, complete blood count, and renal function tests performed for hematuria etiology were found to be normal. In renal ultrasonography, kidneys were at normal size and echogenicity for her age. Hydronephrosis, stone and renal mass were excluded. Complement tests and antinuclear antibody (ANA) were negative. In renal doppler examination, accessory renal vein on the left and also left renal vein with a retroaortic localization drew attention. In computed tomography angiography examination, it was assessed double renal vein that more anterior one among the renal veins was compressed between SMA and aorta and the other one was compressed between the abdominal aorta and vertebral column. (Fig 1) Thus the patient was diagnosed with anterior posterior NCS with LRV duplication. She was followed for hematuria and proteinuria.

Results:

Conclusions:

 Occurrence of both of anterior and posterior NCS is a quite exceptional situation. NCS should be kept in mind in the differential diagnosis of hematuria. Also, LRV variations should be remembered in the differential diagnosis of hematuria and venous anatomy should be shown by advanced imaging methods.