Clinical Features of Nutcracker Syndrome in the Adult

Roh, Mi Oh; Choi, Soo Jeong; Choi, En Suk; Shin, Hyun Joo; Park, Moo Yong; Kim, Jin Kuk; Hwang, Seung Duk; Park, Seong Jin

Abstract

PURPOSE: This study was designed to aid the diagnosis and predict the prognosis of Nutcracker syndrome in adults by understanding its clinical course.
METHODS
We reviewed the records of 22 adult patients diagnosed with Nutcracker syndrome from August 2003 to August 2006 at Soonchunhyang university Bucheon hospital.
RESULTS
The mean age was 24.0+/-12.0 years (15-59) including 13 males and 9 females. Twenty of 22 patients visited our hospital due to hematuria. Combined symptoms were flank pain (7 patients), back pain (2), abdominal pain (2), foamy urine (3), weight loss (1) and fatigue (1). Urine analysis showed hematuria (18 patients), isolated proteinuria (1), combined form (6), and normal findings (3). The mean level of proteinuria was 496.3+/-387.5 mg/d. Patients were diagnosed by doppler ultrasonography (17), abdominal computed tomography (8), and renal angiography (1). The mean ratio of the anterioposterior diameter of the left renal vein (LRV) between the hilar portion and the aortomesenteric (AM) portion was 8.25+/-3.05. The mean peak velocity ratio in the LRV between the AM and hilar portion was 6.09+/-1.47. Renal biopsy was done in the 3 patients with proteinuria >500 mg/day, and revealed membranous glomerulonephritis, IgA nephropathy and normal finding, respectively. Eight patients were followed up in 9.9+/-7.9 months. Only 1 patient showed improvement of hematuria.
CONCLUSION
In the adults with Nutcracker syndrome, other symptoms beyond hematuria occurs. And when proteinuria is presented, the possibility of combined glomerulonephritis must be avoided.