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Uncracking a Case

Nutcracker phenomenon (NCP) refers to compression of the left renal vein (LRV), most frequently between the aorta and the superior mesenteric artery, with impaired blood outflow often accompanied by distention of the distal portion of the vein. The nutcracker syndrome (NCS) is the terminology used w...

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Autores principales: Cardoso, Filipa S., Alves, Patrícia S. C., Góis, Mário R. V., de Simas de Mesquita, Isabel C. B., Neves, Teresa R., Mendes, Marco S. O., Nolasco, Fernando E. B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023035/
https://www.ncbi.nlm.nih.gov/pubmed/33840963
http://dx.doi.org/10.4103/ijn.IJN_286_19
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author Cardoso, Filipa S.
Alves, Patrícia S. C.
Góis, Mário R. V.
de Simas de Mesquita, Isabel C. B.
Neves, Teresa R.
Mendes, Marco S. O.
Nolasco, Fernando E. B.
author_facet Cardoso, Filipa S.
Alves, Patrícia S. C.
Góis, Mário R. V.
de Simas de Mesquita, Isabel C. B.
Neves, Teresa R.
Mendes, Marco S. O.
Nolasco, Fernando E. B.
author_sort Cardoso, Filipa S.
collection PubMed
description Nutcracker phenomenon (NCP) refers to compression of the left renal vein (LRV), most frequently between the aorta and the superior mesenteric artery, with impaired blood outflow often accompanied by distention of the distal portion of the vein. The nutcracker syndrome (NCS) is the terminology used when the nutcracker phenomenon is accompanied by a complex of symptoms such as pain (abdominal, flank, and pelvic), hematuria and orthostatic proteinuria. Diagnosis can be made with Doppler ultrasound (DUS), computed tomography (CT), magnetic resonance imaging (MRI), and venography. We describe a case of a young female adult who was identified with NCP by DUS, after a first CT had found no abnormalities. She presented with flank pain and severe hematuria causing a drastic decrease in hemoglobin levels. The management of NCS depends upon the clinical presentation and the severity of the LRV hypertension. The treatment options range from conservative to nephrectomy. Treatment decision should be based on the age of patients, severity of symptoms, and their expected reversibility. This case describes an underreported disorder that presents with non-specific symptoms, demonstrating the difficulties of the diagnostic approach of NCS, as well as the challenges in the appropriate management, given the lack of standardized treatment.
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spelling pubmed-80230352021-04-08 Uncracking a Case Cardoso, Filipa S. Alves, Patrícia S. C. Góis, Mário R. V. de Simas de Mesquita, Isabel C. B. Neves, Teresa R. Mendes, Marco S. O. Nolasco, Fernando E. B. Indian J Nephrol Case Report Nutcracker phenomenon (NCP) refers to compression of the left renal vein (LRV), most frequently between the aorta and the superior mesenteric artery, with impaired blood outflow often accompanied by distention of the distal portion of the vein. The nutcracker syndrome (NCS) is the terminology used when the nutcracker phenomenon is accompanied by a complex of symptoms such as pain (abdominal, flank, and pelvic), hematuria and orthostatic proteinuria. Diagnosis can be made with Doppler ultrasound (DUS), computed tomography (CT), magnetic resonance imaging (MRI), and venography. We describe a case of a young female adult who was identified with NCP by DUS, after a first CT had found no abnormalities. She presented with flank pain and severe hematuria causing a drastic decrease in hemoglobin levels. The management of NCS depends upon the clinical presentation and the severity of the LRV hypertension. The treatment options range from conservative to nephrectomy. Treatment decision should be based on the age of patients, severity of symptoms, and their expected reversibility. This case describes an underreported disorder that presents with non-specific symptoms, demonstrating the difficulties of the diagnostic approach of NCS, as well as the challenges in the appropriate management, given the lack of standardized treatment. Wolters Kluwer - Medknow 2020 2020-10-09 /pmc/articles/PMC8023035/ /pubmed/33840963 http://dx.doi.org/10.4103/ijn.IJN_286_19 Text en Copyright: © 2020 Indian Journal of Nephrology http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Case Report
Cardoso, Filipa S.
Alves, Patrícia S. C.
Góis, Mário R. V.
de Simas de Mesquita, Isabel C. B.
Neves, Teresa R.
Mendes, Marco S. O.
Nolasco, Fernando E. B.
Uncracking a Case
title Uncracking a Case
title_full Uncracking a Case
title_fullStr Uncracking a Case
title_full_unstemmed Uncracking a Case
title_short Uncracking a Case
title_sort uncracking a case
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023035/
https://www.ncbi.nlm.nih.gov/pubmed/33840963
http://dx.doi.org/10.4103/ijn.IJN_286_19
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