Child Kidney Dis.  2023 Dec;27(2):89-96. 10.3339/ckd.23.018.

Nutcracker syndrome in children: review of symptom, diagnosis, and treatment

• Kalantar DS
• Park SJ
• Shin JI

• KMID: 2549739
• DOI: http://doi.org/10.3339/ckd.23.018

Abstract

Renal nutcracker syndrome (NCS) is the entrapment of the left renal vein between the abdominal aorta and superior mesenteric artery. Although uncommon in pediatric patients, early diagnosis is crucial to avoid potential severe complications, such as anemia or renal vein thrombosis. NCS presents a variety of symptoms, most commonly including “Triade’s symptoms”–hematuria, proteinuria, and flank pain. Diagnosis and treatment include invasive and noninvasive management, although due to a lack of pediatric clinical studies, management is widely variable. Conservative diagnosis and treatment are recommended as a firstline option for pediatric patients; however, invasive surgical treatment may be recommended based on symptom severity. This review aims to provide a comprehensive overview of NCS in children to better understand the widely variable incidence, occurrence, and management from early on to allow for early-onset management.

Keyword

Aorta, abdominal; Mesenteric artery, superior; Renal nutcracker syndrome; Renal veins

Figure

• 

  Fig. 1. Illustration of renal nutcracker syndrome, depicting the compression of the LRV between the abdominal aorta and the SMA. LRA, left renal artery; LRV, left renal vein; SMA, superior mesenteric artery.

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  Fig. 2. Images of Doppler ultrasonography. (A) The diameters of left renal vein in the aortomesenteric portion (0.13 cm) and the hilar portion (0.69 cm). (B) The peak velocity in the aortomesenteric portion (95 cm/sec). (C) The peak velocity in the hilar portion (18 cm/sec). (D) The aortomesenteric angle (18°). Reused from Min et al. Child Kidney Dis 2018;22:75-80 [30].

• 

  Fig. 3. Abdomen and pelvis computed tomography (enhancement). (A) Left renal vein was compressed by the aorta and the superior mesenteric artery (aorto-superior mesenteric artery distance: 4.6 mm). (B) Aortomesenteric angle was 18° in the sagittal plane. Reused from Min et al. Child Kidney Dis 2018;22:75-80 [30].

Reference

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