Nutcracker syndrome: diagnosis and therapy.

Area of Science:

• Vascular Surgery
• Nephrology
• Radiology

Background:

• Nutcracker syndrome (NCS) is characterized by extrinsic compression of the left renal vein (LRV).
• This compression, typically by the superior mesenteric artery and aorta, leads to renal venous congestion.
• Symptoms include hematuria, proteinuria, pain, and potential renal dysfunction, with possible overlap with pelvic congestion syndrome.

Purpose of the Study:

• To review the clinical manifestations of NCS.
• To outline diagnostic criteria and imaging features.
• To discuss current conservative and surgical treatment options.

Main Methods:

• Review of clinical manifestations, diagnostic criteria, and imaging.
• Discussion of conservative management strategies.
• Overview of surgical and endovascular therapies.

Main Results:

• Diagnosis can be challenging, often requiring a combination of imaging and pressure measurements.
• Conservative management, including ACE inhibitors for orthostatic hypotension, is suitable for children.
• Surgical interventions like renal vein transposition and endovascular stenting are options for adults.

Conclusions:

• Nutcracker syndrome requires a comprehensive diagnostic approach.
• Treatment strategies should be tailored to patient age and severity.
• Both conservative and invasive therapies play a role in managing NCS.