The nutcracker syndrome: an underrecognized cause of hematuria

Nutcracker syndrome (NCS) is an uncommon cause of hematuria. It refers to the compression of the left renal vein between the aorta and superior mesenteric artery. It can cause both microscopic and gross hematuria. Hematuria may be associated with left flank pain. The diagnosis of NCS is often delayed. Most patients may have symptoms for many years and non-diagnostic evaluations before accurate diagnosis can be established. It should be included in the differential diagnosis of unexplained hematuria. The diagnosis and treatment of nutcracker syndrome are discussed.

NCS is a rare but treatable clinical condition. An inclusion of this entity in the differential diagnosis of patients with unknown cause of hematuria and flank pain can achieve efficient management of this condition.