NUTCRACKER SYNDROME: INITIAL FINDINGS AND LONG-TERM FOLLOW-UP RESULTS

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Akdemir I., Özçakar Z. B., Akar E. M., Yılmaz S., Çakar N., Fitoz Ö. S.

PEDIATRIC NEPHROLOGY, 2023 (SCI-Expanded) identifier

  • Yayın Türü: Makale / Özet
  • Basım Tarihi: 2023
  • Dergi Adı: PEDIATRIC NEPHROLOGY
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, BIOSIS, CAB Abstracts, CINAHL, MEDLINE, Veterinary Science Database
  • Ankara Üniversitesi Adresli: Evet

Özet

Nutcracker syndrome in pediatrics: initial findings and long‑term

follow‑up results

Iryna Akdemir1 · Ece Mekik Akar2 · Songül Yılmaz2 · Nilgün Çakar2 · Suat Fitöz3 · Zeynep Birsin Özçakar2

Received: 12 June 2023 / Revised: 24 August 2023 / Accepted: 25 August 2023

© The Author(s), under exclusive licence to International Pediatric Nephrology Association 2023

Abstract

Background Nutcracker syndrome (NCS) describes a set of symptoms and signs resulting from compression of the left renal

vein (LRV). There is a lack of knowledge about its natural course, diagnosis, and management, especially in children. Herein,

we present our single-center experience with a large number of patients who have long-term follow-up results.

Methods All patients with NCS diagnosed between January 2011 and March 2021 were included and their data were

obtained retrospectively.

Results A total of 123 NCS patients (85 females) were included. The median age at the time of diagnosis was 12 (IQR 10–14)

years, and BMI percentiles were below 5% in 38% of the cases. At the time of diagnosis, two-thirds of the patients were

asymptomatic. The most common laboratory finding was nephritic proteinuria (98%), followed by microscopic hematuria

(16%). Signs of LRV compression were significantly more evident in upright position Doppler ultrasonography (DUS) examination.

All patients have been followed conservatively; hematuria and/or proteinuria resolved in 43 of the 108 patients (40%)

within 35.8 ± 25.8 months of follow-up. Control DUS was performed in 52 patients after a mean period of 39.1 ± 21.3 months.

The median peak velocity and diameter ratios of the LRV in the upright position were found to be decreased significantly

when compared to the initial assessment (p < 0.05). Normal DUS findings were noted in 13 patients at the final evaluation.

Conclusions In unexplained proteinuria and/or hematuria, NCS should be considered, especially in asthenic adolescents.

Our results support conservative management in children as the first-line treatment approach.