Effectiveness of supine/standing urinalysis for differential diagnosis of left renal vein entrapment syndrome combined with or without glomerulopathy.

AIM: To assess the effectiveness of supine/standing urinalysis for differential diagnosis of left renal vein entrapment syndrome (LRVES) combined with or without glomerulopathy. METHODS: The enrolled patients with abnormal urinalysis and LRVES demonstrated by Doppler sonography were guided to perform a supine/standing urinalysis. RESULTS: Fifty-two patients were enrolled. Most of them were adolescents (aged 14-29 years, 73.1%) and with low body mass index (BMI, mean BMI, 19.8 ± 2.4 kg/m(2)). Seventeen cases (32.7%) manifested orthostatic urine abnormalities (OUA, proteinuria and/or haematuria show negative in supine while positive after 15 min standing), two patients who had undergone renal biopsies both showed no evidence of kidney lesions, another two patients were changed from abnormal to normal urinalysis after weight gain. The remaining 35 cases (67.3%) manifested non-orthostatic urine abnormalities (NOUA, proteinuria and/or haematuria show positive both in supine and standing), 15 patients had undergone renal biopsies and showed different degrees of glomerulopathy. After prednisone/immunosuppression therapy, four patients with glomerulonephritis were changed from the NOUA to the OUA classification. Statistics analyses showed that serum total protein and albumin levels were significantly lower (P = 0.028, 0.007, respectively) and urinary protein was significantly higher (P = 0.007) in the NOUA group than in the OUA group. CONCLUSION: After the indication of LRVES by ultrasound, patients with OUA likely have only LRVES, while patients with NOUA likely also have glomerulopathy. Supine/standing urinalysis combined with Doppler sonography can be helpful for differential diagnosis of LRVES combined with or without glomerulopathy.

Endovascular stent placement for nutcracker phenomenon.

The nutcracker syndrome is a rare clinic condition associated with severe hematuria and left flank pain due to the entrapment of the left renal vein between the superior mesenteric artery and the aorta. Its diagnostic criteria are not well defined, often causing delayed or misdiagnosis. Although surgical repair has been the standard of care, more recently endovascular stenting of the renal vein has been proposed. We presented six patients (aged 7 to 31 years old; median age, 16.5 years old) with nutcracker syndrome who were endovascularly managed from June 2002 to July 2011. All patients underwent laboratory test and computed tomography (CT) or ultrasound examination before and after endovascular procedures. Self-expandable stents were successfully placed in all cases. The diameter of the left renal vein at aorto-superior mesenteric artery portion significantly increased from 1.88 ± 0.95 mm pre-procedure to 5.24 ± 0.61 mm post-procedure (p< 0.01). Left renal vein pressure significantly decreased from 11.00 ± 4.34 mmHg pre-procedure to 6.00 ± 2.55 mmHg post-procedure (p< 0.01). Severe gross hematuria completely subsided within 2 months to 6 months and left flank pain completely subsided within 7 days to 1 month after treatment. Endovascular therapy provides an alternative therapy with satisfactory long-term clinical and imaging results for symptomatic patients with nutcracker syndrome.