ÇOCUKLARDA NUTCRACKER SENDROMU: DOPPLER ULTRASONOGRAFİNİN SEMPTOMATİK HASTALARDAKİ ROLÜ

Year 2019, Volume: 13 Issue: 5, 348 - 352, 23.09.2019

Evrim Cakici , Fatma Yazılıtaş , Hasibe Gökçe Çınar Gökçe Can Eda Didem Kurt Şükür Tülin Güngör Evra Çelikkaya Deniz Karakaya Mehmet Bülbül

https://doi.org/10.12956/tchd.568285

Cited By: 1

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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