Korean Circ J.  2014 Nov;44(6):434-436. 10.4070/kcj.2014.44.6.434.

A Case of Secondary Hypertension Associated with the Nutcracker Phenomenon

• Park SJ
• Kim SM
• Won JH
• Lim HS

• KMID: 2223861
• DOI: http://doi.org/10.4070/kcj.2014.44.6.434

Abstract

A 25-year-old Korean woman was referred for uncontrolled hypertension. Laboratory examination revealed increased plasma renin activity and microscopic hematuria. Computed tomography demonstrated compression of the left renal vein (LRV) between the aorta and superior mesenteric artery; however, both renal arteries were intact and there was no adrenal mass. Renal vein catheterization showed external compression with a pressure gradient of up to 8 mm Hg between the LRV and the inferior vena cava. Plasma renin activity in the LRV was almost five times higher than that in the right renal vein. In this patient, renin-dependent hypertension was caused by renal congestion due to LRV obstruction.

Keyword

Renal nutcracker phenomenon; Hypertension

MeSH Terms

Adult
Aorta
Catheterization
Catheters
Estrogens, Conjugated (USP)
Female
Hematuria
Humans
Hypertension*
Mesenteric Artery, Superior
Plasma
Renal Artery
Renal Nutcracker Syndrome
Renal Veins
Renin
Vena Cava, Inferior
Estrogens, Conjugated (USP)
Renin

Figure

• 

  Fig. 1 An computed tomography image. Contrast-enhanced computed tomography demonstrating compression of the left renal vein between the aorta (Ao) and superior mesenteric artery (SMA) with dilatation of the distal part of the left renal vein (LRV).

• 

  Fig. 2 Venography of the left renal vein. A: left renal vein (LRV) showing poststenotic dilatation. B: perirenal and periureteral collateral veins. C: anomalous reflux of ovarian vein and varices of ovarian plexus (arrow). The pressure gradient between the left renal vein and the inferior vena cava was 8 mm Hg (normal <3 mm Hg) and plasma renin activity in the LRV was almost five times higher than that in the right renal vein (5.88 ng/mL/hr vs. 1.17 ng/mL/hr).

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