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Physical finding of nutcracker phenomenon
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& 2013 International Society of Nephrology Kidney International (2013) 83, 335; doi:10.1038/ki.2012.361
Physical finding of nutcracker phenomenon Takeshi Matsubara1, Osamu Ogawa2 and Motoko Yanagita1 1
Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan and 2Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan Correspondence: Takeshi Matsubara, Department of Nephrology, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho Sakyo-ku, Kyoto 606-8507, Japan. E-mail: [email protected]
A 16-year-old adolescent boy was referred to our department because of severe macrohematuria and anemia. Physical examination revealed a left varicocele (Figure 1, white arrowheads). Urinalysis revealed orthostatic proteinuria with numerous isomorphic red blood cells in the urinary sediment. Abdominal computed tomography scan identified compression of the left renal vein between the superior mesenteric artery and the aorta (Figure 2, black arrow), and dilated spermatic vein (Figure 2, black arrowhead). Cystoscopy revealed macrohematuria only from the left ureteral orifice. The patient was diagnosed as having the nutcracker
Figure 1 | Gross appearance of left varicocele.
Kidney International (2013) 83, 335
phenomenon and no treatment had begun. After 6 months, the patient’s hematuria and anemia spontaneously improved. The nutcracker phenomenon is a rare cause of hematuria. The exact incidence of the symptomatic nutcracker phenomenon is not known, although most cases in the literature have been reported from the Far East. It originates exclusively from the left kidney and is a possible cause of orthostatic proteinuria and hematuria. The left varicocele is often caused by the retrograde flow from the left renal vein into the left spermatic vein, as a result of the elevated renocaval pressure gradient by the nutcracker phenomenon.
Figure 2 | Sequential axial contrast-enhanced computed tomography images with 7-mm section thickness. Axial sections showed dilation of the left renal vein after the aortomesenteric passage (black arrow) with dilated spermatic vein (black arrowhead).
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nephrology image
& 2013 International Society of Nephrology Kidney International (2013) 83, 335; doi:10.1038/ki.2012.361
Physical finding of nutcracker phenomenon Takeshi Matsubara1, Osamu Ogawa2 and Motoko Yanagita1 1
Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan and 2Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan Correspondence: Takeshi Matsubara, Department of Nephrology, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho Sakyo-ku, Kyoto 606-8507, Japan. E-mail: [email protected]
A 16-year-old adolescent boy was referred to our department because of severe macrohematuria and anemia. Physical examination revealed a left varicocele (Figure 1, white arrowheads). Urinalysis revealed orthostatic proteinuria with numerous isomorphic red blood cells in the urinary sediment. Abdominal computed tomography scan identified compression of the left renal vein between the superior mesenteric artery and the aorta (Figure 2, black arrow), and dilated spermatic vein (Figure 2, black arrowhead). Cystoscopy revealed macrohematuria only from the left ureteral orifice. The patient was diagnosed as having the nutcracker
Figure 1 | Gross appearance of left varicocele.
Kidney International (2013) 83, 335
phenomenon and no treatment had begun. After 6 months, the patient’s hematuria and anemia spontaneously improved. The nutcracker phenomenon is a rare cause of hematuria. The exact incidence of the symptomatic nutcracker phenomenon is not known, although most cases in the literature have been reported from the Far East. It originates exclusively from the left kidney and is a possible cause of orthostatic proteinuria and hematuria. The left varicocele is often caused by the retrograde flow from the left renal vein into the left spermatic vein, as a result of the elevated renocaval pressure gradient by the nutcracker phenomenon.
Figure 2 | Sequential axial contrast-enhanced computed tomography images with 7-mm section thickness. Axial sections showed dilation of the left renal vein after the aortomesenteric passage (black arrow) with dilated spermatic vein (black arrowhead).
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