J Korean Soc Pediatr Nephrol.  2006 Apr;10(1):83-88.

Mesangial Hypercellularity in a Patient with Nutcracker Syndrome and Orthostatic Proteinuria

• Lee EJ
• Ha TS

Abstract

Orthostatic or postural proteinuria is a benign condition characterized by the presence of protein in urine samples collected in the upright position during the day and its absence in the supine position. Recently, nutcracker phenomenon has been documented as the source of postural proteinuria. The nutcracker phenomenon refers to compression of the left renal vein between the aorta and superior mesenteric artery, resulting in elevation of pressure in the left renal vein, leading to congestion of the left kidney and occasionally to collateral veins formation. Entrapment of the left renal vein is a cause of left-sided gross hematuria, ureteral and peripelvic varices, unexplained left flank pain and variable degrees of orthostatic proteinuria. We report the case of a 14-year-old girl with orthostatic proteinuria, diagnosed as having nutcracker syndrome by doppler sonography and MR angiography. Because daily protein excretion was more than 1.5 grams over 3 years of follow up, we decided to perform a renal biopsy which revealed moderate mesangial cell proliferation in all glomeruli.

Keyword

Nutcracker syndrome; Orthostatic proteinuria; Mesangial hypercellularity

MeSH Terms

Adolescent
Angiography
Aorta
Biopsy
Estrogens, Conjugated (USP)
Female
Flank Pain
Follow-Up Studies
Hematuria
Humans
Kidney
Mesangial Cells
Mesenteric Artery, Superior
Proteinuria*
Renal Veins
Supine Position
Ureter
Varicose Veins
Veins
Estrogens, Conjugated (USP)