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[Left renal vein hypertension syndrome]
S Mendizábal1, E Román, A Serrano
1Servicio de Nefrología Pediátrica, Hospital Infantil La Fe, Valencia. mendizabal_san@gva.es
Summary
Left renal vein compression, a rare cause of hematuria, can lead to significant symptoms. Early diagnosis and consideration of intervention are key for managing this nutcracker phenomenon.
Area of Science:
- Urology
- Pediatric Nephrology
- Vascular Surgery
Context:
- Left renal vein compression, also known as nutcracker phenomenon, can cause retrograde hypertension.
- This condition presents with hematuria, gonadal vein dilatation, and varicocele, particularly in pediatric patients.
Purpose:
- To describe the diagnostic challenges and treatment approaches for left renal vein compression in children.
- To highlight the association between symptom severity and the degree of venous hypertension.
Summary:
- This study reports on nine children (aged 8-15) with hematuria due to left renal vein hypertension.
- Diagnosis involved ultrasound, Doppler ultrasound, helical CT, and venography, revealing causes like retroaortic renal vein and aortomesenteric compression.
- Interventionist treatment, including auto-transplantation and endovascular stenting, was performed in two severe cases.
Impact:
- Accurate diagnosis of left renal vein compression is crucial, as less invasive methods can yield ambiguous results.
- Understanding the severity of renal vein hyperpressure and collateral circulation is vital for guiding therapeutic decisions.
- Interventionist strategies for this rare hematuria cause must carefully weigh risks and benefits.