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Nutcracker syndrome: diagnosis and therapy.

Marcin K Kolber1, Zhonghao Cui2, Christine K Chen1

  • 1Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.

Cardiovascular Diagnosis and Therapy
|November 24, 2021
PubMed
Summary
This summary is machine-generated.

Nutcracker syndrome (NCS) involves left renal vein compression, causing symptoms like hematuria and pain. Management ranges from conservative care in children to surgical interventions in adults.

Keywords:
Nutcracker syndrome (NCS)hematurialeft renal vein (LRV)vascular compression

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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.