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Renal vein entrapment syndrome: frequency and diagnosis. A lesson in conservatism

N M Wolfish, P N McLaine, D Martin

    Clinical Nephrology
    |August 1, 1986
    PubMed

    Insights

    Left renal vein (LRV) entrapment can cause hematuria in children. Ultrasound and red blood cell analysis are recommended non-invasive tools for diagnosis, avoiding more invasive procedures.

    Area of Science:

    • Pediatric Nephrology
    • Diagnostic Imaging
    • Urology

    Background:

    • Gross hematuria and flank pain in children warrant thorough investigation.
    • Left renal vein (LRV) entrapment is a potential, though often overlooked, cause of these symptoms.

    Observation:

    • Two boys initially presented with gross hematuria and left loin pain, diagnosed via ultrasound (US) with LRV entrapment and isomorphic urinary red blood cells.
    • Over 18 months, two additional boys were diagnosed with LRV entrapment syndrome, confirmed by US and characteristic red blood cell morphology, among ten children investigated for gross hematuria.

    Findings:

    • Renal venography demonstrated a low yield in detecting LRV compression.
    • Urinary red blood cell morphology, particularly isomorphic red cells, along with diagnostic US, proved effective in identifying LRV entrapment syndrome.
    • Asymptomatic patients may exhibit LRV compression, necessitating strict diagnostic criteria for entrapment.

    Implications:

    • Phase microscopy and renal US are recommended as initial, non-invasive diagnostic steps for pediatric hematuria.
    • These simple procedures can help avoid invasive or radiation-dependent investigations.
    • Accurate diagnosis of LRV entrapment syndrome is crucial for appropriate management in pediatric patients.

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