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Cracking haematuria in adolescent with negative work up
Perry Guo1, Vladimir Belostotsky
1Michael G DeGroote School of Medicine, Hamilton, Canada.
BMJ Case Reports
|May 28, 2013
Summary
A teenage girl with persistent visible hematuria was diagnosed with nutcracker syndrome. This condition, left renal vein compression, was identified after extensive negative workups, including imaging and biopsy.
Area of Science:
- Nephrology
- Vascular Medicine
- Pediatric Urology
Background:
- Persistent visible hematuria in adolescents warrants thorough investigation.
- Standard diagnostic workups for hematuria include urinalysis, renal function tests, immunology screens, and imaging.
- Excluding common causes like urinary tract infections and glomerulonephritis is crucial.
Observation:
- A 16-year-old female presented with a two-month history of visible hematuria.
- Initial investigations revealed proteinuria (0-1.5 g/l) but normal kidney function and negative immunology.
- Ultrasound, renal biopsy, and cystoscopy were unremarkable.
Findings:
- CT angiogram identified compression of the left renal vein.
- The findings were consistent with the diagnosis of nutcracker syndrome.
- No arteriovenous malformation was detected.
Implications:
- Nutcracker syndrome should be considered in the differential diagnosis of unexplained hematuria in adolescents.
- Accurate diagnosis via vascular imaging is essential for appropriate management.
- Further research into the long-term outcomes and treatment strategies for pediatric nutcracker syndrome is warranted.
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