Haematuria without diagnosis? Think about the rare causes…

Area of Science:

• Nephrology
• Vascular Medicine
• Pediatric Case Study

Background:

• Recurrent macroscopic haematuria and left lumbar pain in adolescents can present diagnostic challenges.
• Non-glomerular causes of haematuria require thorough investigation to identify underlying pathologies.
• Nutcracker syndrome (NutS) is an uncommon condition involving renal vein compression.

Observation:

• A 17-year-old male presented with a two-month history of intermittent macroscopic haematuria and left lumbar pain.
• Physical examination and vital signs were unremarkable, suggesting a non-obvious etiology.
• Doppler ultrasound revealed left renal vein compression with upstream dilatation, confirmed by CT angiography.

Findings:

• The diagnostic imaging findings were consistent with nutcracker syndrome (NutS).
• NutS, though often asymptomatic, can manifest as a rare cause of haematuria in pediatric patients.
• Conservative management led to the spontaneous resolution of macroscopic haematuria.

Implications:

• This case highlights the importance of considering NutS in the differential diagnosis of unexplained haematuria in children and adolescents.
• High clinical suspicion and appropriate imaging modalities are essential for diagnosing NutS.
• Early diagnosis and conservative treatment can lead to favorable outcomes in pediatric cases of NutS.