Clin Exp Nephrol DOI 10.1007/s10157-015-1112-4

IMAGES IN NEPHROLOGY

Gross hematuria caused by the nutcracker syndrome Koichi Takeda1 • Seiji Minota1

Received: 2 March 2015 / Accepted: 31 March 2015 Ó Japanese Society of Nephrology 2015

Keywords

Hematuria
Nutcracker syndrome

To the Editor An 18-year-old, relatively thin boy visited our hospital with a 2-day history of gross hematuria (Fig. 1) and left flank pain. Enhanced computed tomography revealed compression of the left renal vein (LRV) between the aorta (Ao) and the superior mesenteric artery (SMA), with dilatation of the distal left renal vein (Figs. 2, 3). Based on this finding, the patient was diagnosed with nutcracker syndrome [1]. Thus, we believe that although routine examinations of the kidney and collecting system may not reveal any abnormal signs in a patient with hematuria, physicians should consider whether the patient has nutcracker syndrome. Fig. 1 Gross hematuria

& Koichi Takeda [email protected] 1

Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan

Fig. 2 Enhanced computed tomography

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Moreover, imaging methods such as Doppler ultrasonography, enhanced computed tomography, and magnetic resonance angiography should be used for confirming the diagnosis of nutcracker syndrome in these patients. Conflict of interest

None.

Reference 1. Gulleroglu K, Gulleroglu B, Baskin E. Nutcracker syndrome. World J Nephrol. 2014;3:277–81.

Fig. 3 Enhanced computed tomography

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