Araştırma Makalesi
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Is Nutcracker Syndrome Innocent?

Yıl 2024, Cilt: 24 Sayı: 1, 11 - 14, 07.05.2024
https://doi.org/10.26650/jchild.2024.1393387

Öz

Objective: Nutcracker syndrome (NS) is defined by the compression of the left renal vein by the superior mesenteric artery. The incidence of NS and the exact treatment protocols are not well known. The objective of this study is to analyze children with NS and evaluate the prognosis in follow-up.

Methods: All patients were referred to the pediatric nephrology clinic by pediatricians because of proteinuria. The study includes 74 patients (52 girls, 22 boys) with a mean age of 13.15±2.32 and records the presenting symptoms, degree of proteinuria, and radiologic findings. The diameter ratios of the left renal vein before and after stenosis and peak systolic velocity (PSV) ratios were calculated with a Doppler ultrasound, with a peak systolic ratio of 3.0:1 or greater was accepted as the diagnostic criterion for NS.

Results: The mean age was 13.15±2.32 (5.33-17.42) years, while the mean follow-up duration was 14.6±9.1 months. Proteinuria was not correlated with the degree of compression. Most patients had a good prognosis, and none of them required medical or surgical treatment. A significant reduction or complete normalization of proteinuria was seen in more than half of the patients under conservative management.

Conclusions: Based on our findings, NS seems to have a good prognosis in children who present with isolated proteinuria.

Etik Beyan

2023/0295 numaralı etik kurul kararı ile yapılmıştır.

Destekleyen Kurum

yok

Teşekkür

yok

Kaynakça

  • Wolfish NM, McLaine PN, Martin D . Renal vein entrapment syndrome: frequency and diagnosis. A lesson in conservatism. Clin Nephrol 1986;26(2):96-100. google scholar
  • Pardinhas C, do Carmo C, Gomes C, Escada L, Alves R . Nutcracker Syndrome: A Single-Center Experience. Case Rep Nephrol Dial 2021;11(1):48-54. doi:10.1159/000512589. google scholar
  • K.W. Kim, J.Y. Cho, S.H. Kim, et al. Diagnostic value of computed tomographic findings of nutcracker syndrome: correlation with renal venography and renocaval pressure grandients, Eur. J. Radiol. 2010;80(3):648-54. doi: 10.1016/j.ejrad.2010.08.044. google scholar
  • Avgerinos ED, McEnaney R, Chaer RA. Surgical and endovascular interventions for nutcracker syndrome. Semin Vasc Surg 2013;26(4):170-7. doi: 10.1053/j.semvascsurg.2014.06.014. Epub 2014 Jun 25. google scholar
  • Zhang H, Li M, Jin W.et al. The left renal entrapment syndrome: diagnosis and treatment. Ann Vasc Surg 2007;21(2):198-203. doi: 10.1016/j.avsg.2006.10.021. google scholar
  • Shin JI, Lee JS, Kim MJ . The prevalence, physical characteristics and diagnosis of nutcracker syndrome. Eur J Vasc Endovasc Surg 2006;32(3):335-6. doi: 10.1016/j.ejvs.2006.04.030 google scholar
  • Granata A, Distefano G, Sturiale A, Figuera M, Foti PV, Palmucci S, et al. From Nutcracker Phenomenon to Nutcracker Syndrome: A Pictorial Review. Diagnostics (Basel) 2021;11(1):101. doi: 10.3390/ diagnostics11010101. google scholar
  • Bhanji A, Malcolm P, Karim M. Nutcracker syndrome and radiographic evaluation of loin pain and hematuria. Am J Kidney Dis 2010;55(6):1142-5. doi: 10.1053/j.ajkd.2009.10.010. google scholar
  • He Y, Wu Z, Chen S, Tian L, Li D, Li M, et al. Nutcracker syndrome--how well do we know it? Urology 2014;83(1):12-7. doi: 10.1016/j. urology.2013.08.033. google scholar
  • Vianello FA, Mazzoni MB, Peeters GG, Fossali EF, Camozzi P, Bianchetti MG, et al. Micro- and macroscopic hematuria caused by renal vein entrapment: Systematic review of the literature. Pediatr. Nephrol 2016; 31(2):175-184. doi: 10.1007/s00467-015-3045-2. google scholar
  • Okada M, Tsuzuki K, Ito S. Diagnosis of the nutcracker phenomenon using two-dimensional ultrasonography. Clin Nephrol 1998;49(1)35-40. google scholar
  • Alaygut D, Bayram M, Soylu A.et al. The clinical course of children with Nutcracker syndrome. Urology 2013;82(3):686-90. doi: 10.1016/j.urology.2013.03.048. google scholar
  • Agarwal A, Litra F, Barr LL. A Rare Cause of Abdominal and Flank Pain in Children: Nutcracker Syndrome. Cureus 2021;16;13(7) e16422. doi: 10.7759/cureus.16422. google scholar
  • Nutcracker Waldrop RD, Henning P . Nutcracker Syndrome Masquerading as Renal Colic in an Adolescent Athlete: A Case Report. Clin. Pract. Cases Emerg Med 2021;5:415-8. doi: 10.5811/ cpcem.2021.6.52140. google scholar
  • Gulleroglu K, Gulleroglu B, Baskin E. Nutcracker syndrome. World J. Nephrol 2014;3(4):277-281. doi: 10.5527/wjn.v3.i4.277. google scholar
  • Takebayashi S, Ueki T, Ikeda N, Fujikawa A . Diagnosis of the nutcracker syndrome with color Doppler sonography: correlation with flow patterns on retrograde left renal venography. AJR 1999;172(1):39-43. doi: 10.2214/ajr.172.1.9888735. google scholar
  • Hangge P, Gupta N, Khurana A, et al. Degree of Left Renal Vein Compression Predicts Nutcracker Syndrome. J Clin Med 2018;7(5):107. doi: 10.3390/jcm7050107. google scholar
  • Ananthan K, Onida S, Davies AH. Nutcracker Syndrome: An Update on Current Diagnostic Criteria and Management Guidelines. Eur J Vasc Endovasc Surg 2017;53(6):886-94. doi: 10.1016/j. ejvs.2017.02.015. google scholar
  • Takahashi Y, Sano A, Matsuo M. An ultrasonographic classification for diverse clinical symptoms of pediatric nutcracker phenomenon. Clin Nephrol 2005;64(1):47-54. doi: 10.5414/ cnp64047. google scholar
  • Park SJ, Lim JW, Cho BS, et al. Nutcracker syndrome in children with orthostatic proteinuria: diagnosis on the basis of Doppler sonography. J Ultrasound Med 2002;21(1):39-45; quiz 46. doi:10.7863/jum.2002.21.1.39 google scholar
  • Shin JI, Park JM, Lee JS, et al. Morphologically improved nutcracker syndrome in an 11-year-old girl with hematuria. Pediatr Int 2007; 49(5):677-9. Doi:10.1111/j.1442-200X.2007.02435. google scholar
  • Shin JI, Park JM, Lee JS, Kim MJ. Effect of renal Doppler ultrasound on the detection of nutcracker syndrome in children with hematuria. Eur J Pediatr 2007;166(5):399-404. doi: 10.1007/ s00431-006-0252-7. google scholar
  • Cheon JE, Kim WS, Kim IO, Kim SH, Yeon KM, Ha IS,et al. Nutcracker syndrome in children with gross haematuria: Doppler sonographic evaluation of the left renal vein. Pediatr Radiol 2006;36(7):682-6. doi: 10.1007/s00247-006-0145-y. google scholar
  • Meyer J, Rother U, Stehr M, Meyer A. Nutcracker syndrome in children: Appearance, diagnostics, and treatment - A systematic review. J Pediatr Surg. 2022;57(11):716-722. doi:10.1016/j. jpedsurg.2021.12.019. google scholar
  • Ananthan K, Onida S, Davies AH. Nutcracker Syndrome: An Update on Current Diagnostic Criteria and Management Guidelines. Eur J Vasc Endovasc Surg 2017;53(6):886-94. doi: 10.1016/j. ejvs.2017.02.015. google scholar
  • Kargın Çakıcı E, Yazılıtaş F, Çınar HG. Nutcracker syndrome in children: the role of Doppler ultrasonography in symptomatic patients. Turkish J Pediatr Dis 2019;5: 348-52. google scholar
Yıl 2024, Cilt: 24 Sayı: 1, 11 - 14, 07.05.2024
https://doi.org/10.26650/jchild.2024.1393387

Öz

Kaynakça

  • Wolfish NM, McLaine PN, Martin D . Renal vein entrapment syndrome: frequency and diagnosis. A lesson in conservatism. Clin Nephrol 1986;26(2):96-100. google scholar
  • Pardinhas C, do Carmo C, Gomes C, Escada L, Alves R . Nutcracker Syndrome: A Single-Center Experience. Case Rep Nephrol Dial 2021;11(1):48-54. doi:10.1159/000512589. google scholar
  • K.W. Kim, J.Y. Cho, S.H. Kim, et al. Diagnostic value of computed tomographic findings of nutcracker syndrome: correlation with renal venography and renocaval pressure grandients, Eur. J. Radiol. 2010;80(3):648-54. doi: 10.1016/j.ejrad.2010.08.044. google scholar
  • Avgerinos ED, McEnaney R, Chaer RA. Surgical and endovascular interventions for nutcracker syndrome. Semin Vasc Surg 2013;26(4):170-7. doi: 10.1053/j.semvascsurg.2014.06.014. Epub 2014 Jun 25. google scholar
  • Zhang H, Li M, Jin W.et al. The left renal entrapment syndrome: diagnosis and treatment. Ann Vasc Surg 2007;21(2):198-203. doi: 10.1016/j.avsg.2006.10.021. google scholar
  • Shin JI, Lee JS, Kim MJ . The prevalence, physical characteristics and diagnosis of nutcracker syndrome. Eur J Vasc Endovasc Surg 2006;32(3):335-6. doi: 10.1016/j.ejvs.2006.04.030 google scholar
  • Granata A, Distefano G, Sturiale A, Figuera M, Foti PV, Palmucci S, et al. From Nutcracker Phenomenon to Nutcracker Syndrome: A Pictorial Review. Diagnostics (Basel) 2021;11(1):101. doi: 10.3390/ diagnostics11010101. google scholar
  • Bhanji A, Malcolm P, Karim M. Nutcracker syndrome and radiographic evaluation of loin pain and hematuria. Am J Kidney Dis 2010;55(6):1142-5. doi: 10.1053/j.ajkd.2009.10.010. google scholar
  • He Y, Wu Z, Chen S, Tian L, Li D, Li M, et al. Nutcracker syndrome--how well do we know it? Urology 2014;83(1):12-7. doi: 10.1016/j. urology.2013.08.033. google scholar
  • Vianello FA, Mazzoni MB, Peeters GG, Fossali EF, Camozzi P, Bianchetti MG, et al. Micro- and macroscopic hematuria caused by renal vein entrapment: Systematic review of the literature. Pediatr. Nephrol 2016; 31(2):175-184. doi: 10.1007/s00467-015-3045-2. google scholar
  • Okada M, Tsuzuki K, Ito S. Diagnosis of the nutcracker phenomenon using two-dimensional ultrasonography. Clin Nephrol 1998;49(1)35-40. google scholar
  • Alaygut D, Bayram M, Soylu A.et al. The clinical course of children with Nutcracker syndrome. Urology 2013;82(3):686-90. doi: 10.1016/j.urology.2013.03.048. google scholar
  • Agarwal A, Litra F, Barr LL. A Rare Cause of Abdominal and Flank Pain in Children: Nutcracker Syndrome. Cureus 2021;16;13(7) e16422. doi: 10.7759/cureus.16422. google scholar
  • Nutcracker Waldrop RD, Henning P . Nutcracker Syndrome Masquerading as Renal Colic in an Adolescent Athlete: A Case Report. Clin. Pract. Cases Emerg Med 2021;5:415-8. doi: 10.5811/ cpcem.2021.6.52140. google scholar
  • Gulleroglu K, Gulleroglu B, Baskin E. Nutcracker syndrome. World J. Nephrol 2014;3(4):277-281. doi: 10.5527/wjn.v3.i4.277. google scholar
  • Takebayashi S, Ueki T, Ikeda N, Fujikawa A . Diagnosis of the nutcracker syndrome with color Doppler sonography: correlation with flow patterns on retrograde left renal venography. AJR 1999;172(1):39-43. doi: 10.2214/ajr.172.1.9888735. google scholar
  • Hangge P, Gupta N, Khurana A, et al. Degree of Left Renal Vein Compression Predicts Nutcracker Syndrome. J Clin Med 2018;7(5):107. doi: 10.3390/jcm7050107. google scholar
  • Ananthan K, Onida S, Davies AH. Nutcracker Syndrome: An Update on Current Diagnostic Criteria and Management Guidelines. Eur J Vasc Endovasc Surg 2017;53(6):886-94. doi: 10.1016/j. ejvs.2017.02.015. google scholar
  • Takahashi Y, Sano A, Matsuo M. An ultrasonographic classification for diverse clinical symptoms of pediatric nutcracker phenomenon. Clin Nephrol 2005;64(1):47-54. doi: 10.5414/ cnp64047. google scholar
  • Park SJ, Lim JW, Cho BS, et al. Nutcracker syndrome in children with orthostatic proteinuria: diagnosis on the basis of Doppler sonography. J Ultrasound Med 2002;21(1):39-45; quiz 46. doi:10.7863/jum.2002.21.1.39 google scholar
  • Shin JI, Park JM, Lee JS, et al. Morphologically improved nutcracker syndrome in an 11-year-old girl with hematuria. Pediatr Int 2007; 49(5):677-9. Doi:10.1111/j.1442-200X.2007.02435. google scholar
  • Shin JI, Park JM, Lee JS, Kim MJ. Effect of renal Doppler ultrasound on the detection of nutcracker syndrome in children with hematuria. Eur J Pediatr 2007;166(5):399-404. doi: 10.1007/ s00431-006-0252-7. google scholar
  • Cheon JE, Kim WS, Kim IO, Kim SH, Yeon KM, Ha IS,et al. Nutcracker syndrome in children with gross haematuria: Doppler sonographic evaluation of the left renal vein. Pediatr Radiol 2006;36(7):682-6. doi: 10.1007/s00247-006-0145-y. google scholar
  • Meyer J, Rother U, Stehr M, Meyer A. Nutcracker syndrome in children: Appearance, diagnostics, and treatment - A systematic review. J Pediatr Surg. 2022;57(11):716-722. doi:10.1016/j. jpedsurg.2021.12.019. google scholar
  • Ananthan K, Onida S, Davies AH. Nutcracker Syndrome: An Update on Current Diagnostic Criteria and Management Guidelines. Eur J Vasc Endovasc Surg 2017;53(6):886-94. doi: 10.1016/j. ejvs.2017.02.015. google scholar
  • Kargın Çakıcı E, Yazılıtaş F, Çınar HG. Nutcracker syndrome in children: the role of Doppler ultrasonography in symptomatic patients. Turkish J Pediatr Dis 2019;5: 348-52. google scholar
Toplam 26 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri (Diğer)
Bölüm Araştırma Makaleleri
Yazarlar

Sabriye Gülçin Bozbeyoğlu 0000-0003-1593-4351

Nilüfer Göknar 0000-0003-4376-1216

Yayımlanma Tarihi 7 Mayıs 2024
Gönderilme Tarihi 20 Kasım 2023
Kabul Tarihi 24 Ocak 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 24 Sayı: 1

Kaynak Göster

APA Bozbeyoğlu, S. G., & Göknar, N. (2024). Is Nutcracker Syndrome Innocent?. Journal of Child, 24(1), 11-14. https://doi.org/10.26650/jchild.2024.1393387
AMA Bozbeyoğlu SG, Göknar N. Is Nutcracker Syndrome Innocent?. Journal of Child. Mayıs 2024;24(1):11-14. doi:10.26650/jchild.2024.1393387
Chicago Bozbeyoğlu, Sabriye Gülçin, ve Nilüfer Göknar. “Is Nutcracker Syndrome Innocent?”. Journal of Child 24, sy. 1 (Mayıs 2024): 11-14. https://doi.org/10.26650/jchild.2024.1393387.
EndNote Bozbeyoğlu SG, Göknar N (01 Mayıs 2024) Is Nutcracker Syndrome Innocent?. Journal of Child 24 1 11–14.
IEEE S. G. Bozbeyoğlu ve N. Göknar, “Is Nutcracker Syndrome Innocent?”, Journal of Child, c. 24, sy. 1, ss. 11–14, 2024, doi: 10.26650/jchild.2024.1393387.
ISNAD Bozbeyoğlu, Sabriye Gülçin - Göknar, Nilüfer. “Is Nutcracker Syndrome Innocent?”. Journal of Child 24/1 (Mayıs 2024), 11-14. https://doi.org/10.26650/jchild.2024.1393387.
JAMA Bozbeyoğlu SG, Göknar N. Is Nutcracker Syndrome Innocent?. Journal of Child. 2024;24:11–14.
MLA Bozbeyoğlu, Sabriye Gülçin ve Nilüfer Göknar. “Is Nutcracker Syndrome Innocent?”. Journal of Child, c. 24, sy. 1, 2024, ss. 11-14, doi:10.26650/jchild.2024.1393387.
Vancouver Bozbeyoğlu SG, Göknar N. Is Nutcracker Syndrome Innocent?. Journal of Child. 2024;24(1):11-4.