ÇOCUKLARDA NUTCRACKER SENDROMU: DOPPLER ULTRASONOGRAFİNİN SEMPTOMATİK HASTALARDAKİ ROLÜ

Abstract

Amaç: Bu çalışmanın amacı, Nutcracker sendromu tanısı almış pediatrik hastaların klinik özelliklerini değerlendirmek ve klinik belirtilerle sol renal ven doppler ultrasonografi bulguları arasında bir ilişki olup olmadığını belirlemektir.

Gereç ve yöntemler: Ocak 2015- Aralık 2018 tarihleri arasında, Nutcracker sendromu tanısı alan hastaların klinik verileri geriye dönük olarak incelendi. Hastalar semptomatik (yan ağrısı, makroskopik hematüri veya her ikisi) ve semptomatik olmayan (tesadüfen saptanan mikroskobik hematüri ve proteinüri) olarak gruplandırıldı ve bu iki gruptaki doppler ultrasonografi bulguları değerlendirildi.

Bulgular: Nutcracker sendromu tanısı olan 41 hasta (28 kız ve 11 erkek hasta, ortalama yaş 13,6±3,37 yıl) çalışmaya dahil edildi. 26 (%63,4) hastada asemptomatik Nutcracker sendromu bulundu ve bu hastaların %46,1’i mikroskobik hematüri ve %42,3’ü izole proteinüri değerlendirilmesi için başvurdu. En sık görülen belirtiler sol yan ağrısı (%33,3), sol yan ağrısı ile hematüri birlikteliği (%26,6) idi. Sol renal ven hiler bölüm çapının aortomesenterik bölüm çapına oranının ortalama değeri 5,07±1,02 idi. Sol renal ven aorta-mezenterik/hiler bölge pik akım oranı ortalaması 7,17±1,86 saptandı. Pik akım oranları asemptomatik çocuklarda semptomatik gruba göre anlamlı derecede yüksekti (p=0.041).

Çıkarım: Nutcracker sendromu tanısı, proteinüri ve hematüri gibi belirtilerin varlığında düşünülmeli ve böbrek biyopsisinden önce mutlaka ekarte edilmelidir. Ek olarak çalışmamız, sol renal vende artmış kompresyonun çoğunlukla mikroskobik hematüri ve proteinüri olan hastalarda gözlendiğini göstermiştir. 

Keywords

• Çocuk,Doppler ultrasonografi,Nutcracker sendromu,Sol renal ven

NUTCRACKER SYNDROME IN CHILDREN: THE ROLE OF DOPPLER ULTRASONOGRAPHY IN SYMPTOMATIC PATIENTS

Abstract

Objective: The aim of this study is to evaluate the clinical characteristics of pediatric patients with Nutcracker syndrome and to determine whether there is a relationship between clinical signs and left renal vein doppler ultrasonography findings.

Materials and methods: Between January 2015 and December 2018, clinical data of patients diagnosed with Nutcracker syndrome were retrospectively reviewed. Patients were devided into two groups as symptomatic (loin pain, macroscopic hematuria or both) and non-symptomatic (incidentally detected microscopic hematuria and proteinuria), and the doppler ultrasonography findings in both group were evaluated.

Results: Fourty-one patients (28 female and 11 male patients, mean age 13,6±3,37 years) with the diagnosis of Nutcracker syndrome were included the study. Asymptomatic Nutcracker syndrome was found in 26 (63.4%) patients; in whom 46.1% were admitted for the evaluation of proteinuria and 42.3% for isolated proteinuria. The most frequent symptoms were left flank pain (33.3%), left flank pain and hematuria together (26.6%). The mean ratio of the diameter of the hilar portion of the left renal vein to that of the aortomesenteric portion was 5,07±1,02. The mean peak velocity ratio of the left renal vein aorta-mesenteric/hiler portion was found to be 7,17±1,86. The peak velocity ratios of the LRV (p = 0.041) were significantly higher in asymptomatic children with Nutcracker syndrome than in the symptomatic group.

Conclusion: The diagnosis of Nutcracker syndrome should be considered in the presence of symptoms such as proteinuria and hematuria and should be absolutely ruled out before attempting renal biopsy. In addition, our study showed that increased compression of the left renal vein is mostly observed in proteinuria and microscopic hematuria.

Keywords

• Child,Doppler ultrasonography,Nutcracker syndrome

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