Korean Journal of Nephrology 2007;26(2):167-173.
Original Article : Clinical Features of Nutcracker Syndrome in the Adult
Mi Oh Roh, M.D.1, Soo Jeong Choi, M.D.1, En Suk Choi, M.D.1, Hyun Joo Shin, M.D.1,Moo Yong Park, M.D.1, Jin Kuk Kim, M.D.1, Seung Duk Hwang, M.D.1 and Seong Jin Park, M.D.2
Department of Internal Medicine College of Medicine1 and Diagnositc Radiology2 Soonchunhyang University, Bucheon, Korea
임상연구 : 성인에서 Nutcracker Syndrome의 임상양상
순천향대학교 의과대학 내과학교실1, 진단영상의학과학교실2
This study was designed to aid the diagnosis and predict the prognosis of Nutcracker syndrome in adults by understanding its clinical course.
We reviewed the records of 22 adult patients diagnosed with Nutcracker syndrome from August 2003 to August 2006 at Soonchunhyang university Bucheon hospital.
The mean age was 24.0±12.0 years (15-59) including 13 males and 9 females. Twenty of 22 patients visited our hospital due to hematuria. Combined symptoms were flank pain (7 patients), back pain (2), abdominal pain (2), foamy urine (3), weight loss (1) and fatigue (1). Urine analysis showed hematuria (18 patients), isolated proteinuria (1), combined form (6), and normal findings (3). The mean level of proteinuria was 496.3±387.5 mg/d. Patients were diagnosed by doppler ultrasonography (17), abdominal computed tomography (8), and renal angiography (1). The mean ratio of the anterioposterior diameter of the left renal vein (LRV) between the hilar portion and the aortomesenteric (AM) portion was 8.25±3.05. The mean peak velocity ratio in the LRV between the AM and hilar portion was 6.09±1.47. Renal biopsy was done in the 3 patients with proteinuria >500 mg/day, and revealed membranous glomerulonephritis, IgA nephropathy and normal finding, respectively. Eight patients were followed up in 9.9±7.9 months. Only 1 patient showed improvement of hematuria.
In the adults with Nutcracker syndrome, other symptoms beyond hematuria occurs. And when proteinuria is presented, the possibility of combined glomerulonephritis must be avoided. Key Words : Renal vein, Hematuria, Doppler ultrasonography
Key Words: Renal vein, Hematuria, Doppler ultrasonography

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