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Year : 2020  |  Volume : 30  |  Issue : 6  |  Page : 420--423

Uncracking a case

Filipa S Cardoso1, Patrícia S. C. Alves1, Mário R. V. Góis1, Isabel C. B. de Simas de Mesquita2, Teresa R Neves3, Marco S. O. Mendes1, Fernando E. B. Nolasco1 
1 Department of Nephrology, Centro Hospitalar Lisboa Central EPE, Hospital Curry Cabral, R. Beneficência 8, Lisboa, Portugal
2 Department of Nephrology, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
3 Department of Radiology, Centro Hospitalar Lisboa Central EPE, Hospital Curry Cabral, Lisboa, Portugal

Correspondence Address:
Dr. Filipa S Cardoso
Centro Hospitalar Lisboa Central EPE, Hospital Curry Cabral, Nephrology, R. Beneficência 8, 1050-099 Lisboa
Portugal

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.

How to cite this article:
Cardoso FS, Alves PS, Góis MR, de Simas de Mesquita IC, Neves TR, Mendes MS, Nolasco FE. Uncracking a case.Indian J Nephrol 2020;30:420-423

How to cite this URL:
Cardoso FS, Alves PS, Góis MR, de Simas de Mesquita IC, Neves TR, Mendes MS, Nolasco FE. Uncracking a case. Indian J Nephrol [serial online] 2020 [cited 2021 Oct 26 ];30:420-423
Available from: https://www.indianjnephrol.org/article.asp?issn=0971-4065;year=2020;volume=30;issue=6;spage=420;epage=423;aulast=Cardoso;type=0