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1.
BMJ Case Rep ; 17(7)2024 Jul 01.
Article in English | MEDLINE | ID: mdl-38955381

ABSTRACT

Percutaneous testicular varicocele embolisation for symptomatic and subfertile males is often preferred over surgical ligation of the gonadal vein due to its minimally invasive approach and reduced complication rate. Glues, coils, vascular plugs, balloons and sclerosants are used in various combinations to achieve sufficient venous occlusion. Here, we report on the first known case of sclerosant material migration beyond the placement of an embolisation coil for treatment of a varicocele, resulting in a left renal vein thrombus. A man in his 20s presented to the emergency department 2 days following uncomplicated left varicocele embolisation with acute left-sided abdominal pain, found to have sclerosant material causing an ipsilateral non-occlusive left renal vein thrombus with extension towards his inferior vena cava on CT. He was treated with 3 months of anticoagulation and follow-up imaging at 3 months showed resolution of this thrombus without renal impairment.


Subject(s)
Embolization, Therapeutic , Renal Veins , Varicocele , Humans , Male , Varicocele/therapy , Embolization, Therapeutic/methods , Embolization, Therapeutic/adverse effects , Renal Veins/diagnostic imaging , Foreign-Body Migration , Sclerosing Solutions/administration & dosage , Sclerosing Solutions/therapeutic use , Adult , Young Adult , Tomography, X-Ray Computed
2.
Tokai J Exp Clin Med ; 49(2): 63-66, 2024 Jul 20.
Article in English | MEDLINE | ID: mdl-38904236

ABSTRACT

The isolated absence of the azygos vein was incidentally found on computed tomography (CT) examination in a 60-year-old female. The exact anomaly can be evaluated on high-resolution images of 0.4-mm slice thickness with low keV using photon-counting detector CT. The azygos vein, including the azygos arch, was absent, and a mildly dilated hemiazygos vein flowed to the left brachiocephalic vein through the left superior intercostal vein. A hemiazygos vein connected the left renal vein at the level of the first lumbar vertebra. This patient was the second patient to undergo evaluation using volume rendering images. High-resolution maximum-intensity projection images were useful for assessing the anatomy. Radiation dose was decreased compared with that in conventional CT.


Subject(s)
Azygos Vein , Tomography, X-Ray Computed , Humans , Azygos Vein/diagnostic imaging , Azygos Vein/abnormalities , Female , Middle Aged , Tomography, X-Ray Computed/methods , Photons , Incidental Findings , Radiation Dosage , Renal Veins/diagnostic imaging , Renal Veins/abnormalities
3.
World J Urol ; 42(1): 360, 2024 May 29.
Article in English | MEDLINE | ID: mdl-38811391

ABSTRACT

PURPOSE: To estimate the incidences of left renal vein (LRV) entrapment by right renal artery (RRA), a phenomenon primarily reported as case reports. METHODS: The cross-sectional study consecutively screened renal vessel CT data of 38 (Renal) patients with nephropathy and 305 (Non-renal) patients with peripheral arterial diseases in a teaching hospital in northeast China between November 2018 and March 2023. The LRV compression by adjacent anatomical structures, including but not limited to RRA and multiple compression-related parameters, were investigated through multiplanar analysis of the CT data. RESULTS: The overall LRV entrapment rates by adjacent structures were 41.93% (12/31) and 24.00% (6/25), the rates of RRA-sourced LRV compression 22.58% (7/31) and 20.00% (5/25), and the rates of compression by superior mesenteric artery (SMA) 16.13% (5/31) and 4.00% (1/25) in the Renal and Non-renal groups, respectively, with no significance. The venous segments distal to the RRA-compressed site had a significantly larger transectional lumen area than those of the non-compressed veins in both groups (3.09 ± 1.29 vs. 1.82 ± 0.23, p < 0.001 and 4.30 ± 2.65 vs. 2.12 ± 0.55, p = 0.006; maximum-to-minimum area ratios in Renal and Non-renal groups, respectively). Nearly 80% of RRAs were found arising anteriorly rightwards instead of passing straight to the right. CONCLUSION: RRA-sourced LRV compression was not rare, and its incidence was higher than that of the compression by SMA in both patient cohorts. RRA could be a more common compression source than SMA concerning LRV entrapment. Further investigations involving different populations, including healthy individuals, are needed.


Subject(s)
Renal Artery , Renal Veins , Humans , Cross-Sectional Studies , Middle Aged , Male , Female , Renal Veins/diagnostic imaging , Renal Veins/abnormalities , Aged , Renal Artery/diagnostic imaging , Adult , Tomography, X-Ray Computed , Renal Nutcracker Syndrome/complications , Renal Nutcracker Syndrome/diagnostic imaging , Incidence
4.
Vasc Endovascular Surg ; 58(6): 669-675, 2024 Aug.
Article in English | MEDLINE | ID: mdl-38641903

ABSTRACT

This case report highlights the successful application of a robotic-assisted surgical approach in managing Nutcracker syndrome. The patient, a 36-year-old female presented with severe symptoms and underwent robotic left renal vein transposition after failing conservative management. The procedure was performed through a minimally invasive approach utilizing the Da Vinci robotic system™ which offers enhanced visualization and precision. However, challenges arose during the renal vein anastomosis due to tension and poor flow through the transposition, requiring two revisions with a bovine pericardial patch. Ultimately, an 8 mm ringed PTFE bypass was anastomosed from the distal left renal vein to the Inferior Vena Cava. Despite these challenges, the patient experienced a successful outcome with complete symptom resolution of this complicated pathology.


Subject(s)
Renal Nutcracker Syndrome , Renal Veins , Robotic Surgical Procedures , Humans , Female , Adult , Renal Veins/surgery , Renal Veins/diagnostic imaging , Renal Veins/physiopathology , Renal Nutcracker Syndrome/surgery , Renal Nutcracker Syndrome/diagnostic imaging , Renal Nutcracker Syndrome/physiopathology , Treatment Outcome , Vena Cava, Inferior/surgery , Vena Cava, Inferior/diagnostic imaging , Phlebography/methods , Polytetrafluoroethylene , Blood Vessel Prosthesis Implantation/instrumentation , Computed Tomography Angiography
5.
J Ultrasound Med ; 43(8): 1543-1562, 2024 Aug.
Article in English | MEDLINE | ID: mdl-38654477

ABSTRACT

Ultrasound is the first-line imaging modality used in patients with suspected renovascular disease. Common indications include renovascular hypertension and unexplained renal dysfunction. We review the ultrasound imaging findings of various pathologies involving the renal vessels, including the renal arteries (atherosclerotic stenosis, fibromuscular dysplasia, dissection, arteriovenous fistula, and aneurysm) and veins (tumor and bland thrombus as well as vascular compression syndromes). The current role of renal artery stent placement for atherosclerotic stenosis is also discussed.


Subject(s)
Kidney , Renal Artery , Renal Veins , Ultrasonography, Doppler , Humans , Renal Artery/diagnostic imaging , Renal Veins/diagnostic imaging , Kidney/blood supply , Kidney/diagnostic imaging , Ultrasonography, Doppler/methods , Kidney Diseases/diagnostic imaging
6.
J Nephrol ; 37(4): 1063-1075, 2024 May.
Article in English | MEDLINE | ID: mdl-38594600

ABSTRACT

BACKGROUND: Nutcracker syndrome is a disease characterized by complex symptoms, making its diagnosis challenging and often delayed, often resulting in a painful experience for the patients. OBJECTIVE: This study aimed to investigate the pathogenesis of nutcracker syndrome through the perspective of hemodynamics by simulating blood flow with varying compression degrees of the left renal vein. METHODS: 3D patient-specific vascular models of the abdominal aorta, superior mesenteric artery and left renal vein were constructed based on CT images of patients suspected of having nutcracker syndrome. A hemodynamic simulation was then conducted using computational fluid dynamics to identify the correlation between alterations in hemodynamic parameters and varying degrees of compression. RESULTS: The study indicated the presence of an evident gradient in velocity distribution over the left renal vein with relatively high degrees of stenosis (α ≤ 50°), with maximum velocity in the central region of the stenosis. Additionally, when the compression degree of the left renal vein increases, the pressure distribution of the left renal vein presents an increasing number of gradient layers. Furthermore, the wall shear stress shows a correlation with the variation of blood flow velocity, i.e., the increase of wall shear stress correlates with the acceleration of the blood flow velocity. CONCLUSIONS: Using computational fluid dynamics as a non-invasive instrument to obtain the hemodynamic characteristics of nutcracker syndrome is feasible and could provide insights into the pathological mechanisms of the nutcracker syndrome supporting clinicians in diagnosis.


Subject(s)
Hemodynamics , Renal Nutcracker Syndrome , Renal Veins , Humans , Renal Nutcracker Syndrome/physiopathology , Renal Nutcracker Syndrome/diagnostic imaging , Renal Veins/physiopathology , Renal Veins/diagnostic imaging , Blood Flow Velocity , Aorta, Abdominal/physiopathology , Aorta, Abdominal/diagnostic imaging , Mesenteric Artery, Superior/physiopathology , Mesenteric Artery, Superior/diagnostic imaging , Models, Cardiovascular , Hydrodynamics , Male , Female , Adult , Patient-Specific Modeling , Stress, Mechanical , Imaging, Three-Dimensional , Computer Simulation
7.
J Med Case Rep ; 18(1): 201, 2024 Apr 23.
Article in English | MEDLINE | ID: mdl-38649941

ABSTRACT

BACKGROUND: Renal cell carcinomas are the most common form of kidney cancer in adults. In addition to metastasizing in lungs, soft tissues, bones, and the liver, it also spreads locally. In 2-10% of patients, it causes a thrombus in the renal or inferior vena cava vein; in 1% of patients thrombus reaches the right atrium. Surgery is the only curative option, particularly for locally advanced disease. Despite the advancements in laparoscopic, robotic and endovascular techniques, for this group of patients, open surgery continues to be among the best options. CASE REPORT: Here we present a case of successful tumor thrombectomy from the infrahepatic inferior vena cava combined with renal vein amputation and nephrectomy. Our patient, a 58 year old Albanian woman presented to the doctors office with flank pain, weight loss, fever, high blood pressure, night sweats, and malaise. After a comprehensive assessment, which included urine analysis, complete blood count, electrolytes, renal and hepatic function tests, as well as ultrasonography and computed tomography, she was diagnosed with left kidney renal cell carcinoma involving the left renal vein and subhepatic inferior vena cava. After obtaining informed consent from the patient we scheduled her for surgery, which went well and without complications. She was discharged one week after to continue treatment with radiotherapy, chemotherapy, and immunotherapy. CONCLUSION: Open surgery is a safe and efficient way to treat renal cell carcinoma involving the renal vein and inferior vena cava. It is superior to other therapeutic modalities. When properly done it provides acceptable long time survival and good quality of life to patients.


Subject(s)
Carcinoma, Renal Cell , Kidney Neoplasms , Nephrectomy , Thrombectomy , Vena Cava, Inferior , Humans , Carcinoma, Renal Cell/surgery , Carcinoma, Renal Cell/pathology , Carcinoma, Renal Cell/secondary , Vena Cava, Inferior/pathology , Female , Kidney Neoplasms/pathology , Kidney Neoplasms/surgery , Middle Aged , Nephrectomy/methods , Thrombectomy/methods , Renal Veins/pathology , Renal Veins/diagnostic imaging , Venous Thrombosis/surgery , Venous Thrombosis/etiology , Tomography, X-Ray Computed , Treatment Outcome , Amputation, Surgical
9.
J Vasc Interv Radiol ; 35(7): 979-988.e1, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38537737

ABSTRACT

PURPOSE: To assess the different adjunctive catheter techniques required to achieve complete occlusion of renal arteriovenous malformations (rAVMs) of different angioarchitectural types. MATERIALS AND METHODS: Overall, data on 18 patients with rAVM (Type 1, n = 7; Type 2, n = 2; Type 3, n = 9; mean age, 53.8 years) who underwent 25 procedures between 2011 and 2022 were reviewed. The clinical presentations, endovascular techniques, arteriovenous malformation (AVM) occlusion rate, adverse events (including the incidence of renal infarction), and clinical symptoms and outcomes (including recurrence/increase of AVM) were analyzed according to the Cho-Do angioarchitectural classification. Posttreatment renal infarction was classified as no infarction, small infarction (<12.5%), medium infarction (12.5%-25%), and large infarction (>25%) using contrast-enhanced computed tomography or magnetic resonance imaging. RESULTS: Hematuria and heart failure were presenting symptoms in 10 and 2 patients, respectively. The embolic materials used were as follows: Type 1 rAVM, coils alone or with n-butyl-2-cyanoacrylate (nBCA); Type 2 rAVM, nBCA alone or with coils; and Type 3 rAVMs, nBCA alone. Fourteen patients underwent adjunctive catheter techniques, including flow control with a balloon catheter and multiple microcatheter placement, alone or in combination. Immediate postprocedural angiography revealed complete occlusion in 15 patients (83%) and marked regression of rAVM in 3 (17%). Small asymptomatic renal infarctions were observed in 6 patients with Type 3 rAVMs without any decrease in renal function. No major adverse events were observed. All symptomatic patients experienced symptom resolution. Recurrence/increase of rAVM was not observed during the mean 32-month follow-up period (range, 2-120 months). CONCLUSIONS: Transarterial embolization using adjunctive catheter techniques according to angioarchitectural types can be an effective treatment for rAVMs.


Subject(s)
Arteriovenous Malformations , Embolization, Therapeutic , Renal Artery , Renal Veins , Humans , Middle Aged , Female , Male , Embolization, Therapeutic/adverse effects , Arteriovenous Malformations/therapy , Arteriovenous Malformations/diagnostic imaging , Treatment Outcome , Adult , Retrospective Studies , Aged , Renal Artery/diagnostic imaging , Renal Artery/abnormalities , Renal Veins/diagnostic imaging , Renal Veins/abnormalities , Computed Tomography Angiography , Predictive Value of Tests , Recurrence , Time Factors , Young Adult , Risk Factors , Enbucrilate/administration & dosage , Infarction/diagnostic imaging , Infarction/etiology , Infarction/therapy , Magnetic Resonance Angiography
10.
BMJ Case Rep ; 17(3)2024 Mar 18.
Article in English | MEDLINE | ID: mdl-38499354

ABSTRACT

An elderly man was referred to vascular surgery on incidental discovery of a left retroperitoneal mass ultimately found to be of left renal vein (LRV) origin. He initially presented with recurring lower back pain. CT of the abdomen/pelvis showed a 6.0×5.5 cm lobulated retroperitoneal mass anterior to the infrarenal aorta. Resection of the mass necessitated a multidisciplinary team consisting of medical oncologists, radiation oncologists, urologists and vascular surgeons. In efforts to obtain an R0 margin, en-bloc resection of the LRV from its confluence with the inferior vena cava (IVC) was necessary. A primary repair of the IVC was performed with preservation of the left kidney. The patient's back pain has since resolved after the surgery. A literature search found IVC reconstructions to be safe and effective in the removal of vascular leiomyosarcomas.


Subject(s)
Leiomyosarcoma , Vascular Neoplasms , Male , Humans , Aged , Renal Veins/diagnostic imaging , Renal Veins/surgery , Leiomyosarcoma/diagnostic imaging , Leiomyosarcoma/surgery , Neoplasm Recurrence, Local , Vena Cava, Inferior/diagnostic imaging , Vena Cava, Inferior/surgery , Kidney , Vascular Neoplasms/diagnostic imaging , Vascular Neoplasms/surgery
11.
BMJ Case Rep ; 17(3)2024 Mar 05.
Article in English | MEDLINE | ID: mdl-38442978

ABSTRACT

A primipara in her late 20s presented with abdominal pain and pain in the left flank 14 days after a ventouse delivery. She was treated with antibiotics, antiemetics and analgesics with the initial differential diagnosis of cystitis, pyelonephritis or nephrolithiasis. Despite the treatment, the patient experienced increased colic pain and nausea. An ultrasound showed an enlarged left kidney, suggesting pyelonephritis, and thereby, the antibiotic treatment was adjusted accordingly. Despite additional pain medication, pain relief could not be achieved. The diagnosis of ovarian venous thrombosis was considered, and an abdominal CT scan confirmed the diagnosis. The patient was treated with anticoagulant therapy. Hypercoagulability work-up revealed a heterozygous mutation of the Factor V Leiden. Our patient awaits a haematologic follow-up.


Subject(s)
Pyelonephritis , Thrombosis , Female , Humans , Pregnancy , Abdominal Pain/etiology , Anti-Bacterial Agents , Delivery, Obstetric , Excipients , Renal Veins/diagnostic imaging , Adult
12.
Nephrology (Carlton) ; 29(6): 375-378, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38404136

ABSTRACT

Albeit rare, renal vein abnormalities on autopsy and in cases of abdominal surgery complications have been reported and should be kept in mind when performing invasive procedures, such as renal biopsy. We detected a rare renal vein abnormality on colour Doppler ultrasound before renal biopsy, thereby, avoiding a haemorrhagic complication. A 10-year-old boy presented to our department for the first time because of incidental findings of haematuria and proteinuria. We suspected chronic glomerulonephritis and scheduled an ultrasound-guided percutaneous renal biopsy. A simple screening ultrasound at the initial visit revealed no renal or vascular abnormalities. The day before the renal biopsy, we confirmed the biopsy site by performing a colour Doppler ultrasound, which showed abnormal blood flow from the lower pole of the left kidney, which was the planned puncture site; therefore, we changed the biopsy site to the right and completed the examination. Subsequent computed tomography angiography depicted two renal veins; one was the usual left renal vein draining from the kidney hilum, and the second was an accessory vein draining from the inferior pole of the left kidney and entering the inferior vena cava through the dorsal side of the aorta. Although rare, abnormalities in the renal vessels on the inferior pole of the kidney, which is the usual site of renal biopsy, are essential to rule out preoperatively by colour Doppler ultrasound, because these can cause significant bleeding during renal biopsy if not recognized.


Subject(s)
Renal Veins , Ultrasonography, Doppler, Color , Humans , Male , Renal Veins/diagnostic imaging , Renal Veins/pathology , Child , Kidney/pathology , Kidney/blood supply , Kidney/diagnostic imaging , Predictive Value of Tests , Computed Tomography Angiography , Hemorrhage/etiology , Hemorrhage/prevention & control , Preoperative Care/methods , Biopsy/adverse effects , Biopsy/methods
13.
Ann Vasc Surg ; 102: 110-120, 2024 May.
Article in English | MEDLINE | ID: mdl-38296038

ABSTRACT

BACKGROUND: Nutcracker syndrome is a rare condition that occurs as a result of the entrapment of the left renal vein (LRV) between the aorta and the superior mesenteric artery. It is typically associated with symptoms such as left flank pain, hematuria, proteinuria, and pelvic congestion. The current treatment approach may be conservative in the presence of tolerable symptoms, and surgical or hybrid and stenting procedures in the order of priority in the presence of intolerable symptoms. The aim of this study is to review our experiences to evaluate the results of both methods in this series in which we have a greater tendency toward surgery instead of stenting. METHODS: The clinical data of consecutive patients with nutcracker syndrome who underwent LRV transposition and LRV stenting between July 2019 and October 2023 were retrospectively reviewed. The patients were divided into 2 groups based on the methods of treatment: surgical and stenting. For procedure selection, LRV transposition was primarily recommended, with stenting offered to those who declined. Primary end points were morbidity and mortality. Secondary end points included late complications, patency, freedom from reintervention, and resolution of symptoms. Standard basic statistics and survival analysis methods were employed. RESULTS: Nineteen patients with nutcracker syndrome (female: 100%) were treated with LRV stentings (n = 5) and LRV transposition (n = 14). The mean age was 24 (20-27, interquartile range [IQR]) years. The mean follow-up was 23 (9-32, IQR) months. There were no major complications and mortality after both procedures. The most frequent sign and symptom associated with LRV entrapment were left flank pain 100% (n = 19), proteinuria 88% (n = 15), and hematuria 47% (n = 9). The mean peak velocity ratio on Doppler ultrasound was 6.13 (6-6.44, IQR). Aortomesenteric angle, beak angle (beak sign), and mean diameter ratio on computed tomography were 26° (22.6-28.5, IQR), 25° (23.9-28, IQR), and 5.3 (5-6, IQR), respectively. Venous pressure measurements were only used to confirm the diagnosis in 5 patients in the stenting group. The measured renocaval gradient was 4 (3.9-4.4, IQR) mm Hg. After both procedures, the classical symptoms, including left flank pain, proteinuria, and hematuria, resolved in 89.5% (n = 17), 57.8% (n = 11), and 82.3% (n = 15) of the cases, respectively. A total of 4 patients required reintervention, 3 patients after LRV transposition (occlusion, n = 2; stenosis, n = 1), and 1 patient after stenting (occlusion, n = 1). The 1-year and 3-year primary patency for the 19 patients was 87% and 80%, respectively. Three-year primary-assisted patency was 100%. Similarly, the 1-year and 3-year freedom from reintervention rate was 83% and 72%, respectively. Additionally, the 1-year and 3-year primary patency for the surgical group was 91% and 81%, respectively, and the 1-year and 3-year primary patency for the stenting group was 75%. CONCLUSIONS: Nutcracker syndrome should be kept in mind in cases where flank pain and hematuria cannot be associated with kidney diseases. Radiographic evidence must be accompanied by serious symptoms to initiate the treatment of nutcracker syndrome with LRV transposition and endovascular stenting procedures. Both procedures, along with their respective advantages and disadvantages, can be preferred as primary treatments for nutcracker syndrome. Our study demonstrates that both procedures can be safely and effectively performed, yielding good outcomes.


Subject(s)
Renal Nutcracker Syndrome , Vascular Diseases , Humans , Female , Renal Veins/diagnostic imaging , Renal Veins/surgery , Flank Pain/etiology , Hematuria/etiology , Retrospective Studies , Treatment Outcome , Renal Nutcracker Syndrome/complications , Renal Nutcracker Syndrome/diagnostic imaging , Renal Nutcracker Syndrome/surgery , Vascular Diseases/complications , Proteinuria/complications
14.
J Vasc Surg Venous Lymphat Disord ; 12(1): 101668, 2024 Jan.
Article in English | MEDLINE | ID: mdl-37625506

ABSTRACT

OBJECTIVE: We evaluated the effect of left renal vein (LRV) compression stenosis on the functional state of the left kidney in patients with pelvic venous disorders (PeVDs). METHODS: We examined 162 female patients with PeVD and diagnosed LVR compression stenosis using duplex ultrasound (DUS) in 40. Patients with clinical manifestations of PeVD (n = 26) had symptoms and signs of pelvic venous congestion but without pain in the left flank of the abdomen, typical for nutcracker syndrome (NS). The remaining patients were asymptomatic (n = 14). The parameters measured with DUS included the angle of the superior mesenteric artery (SMA) with the aorta, the LRV diameter (Dhilum/Dstenosis) ratio, and LRV velocity (Vstenosis/Vhilum) ratio. All the patients underwent laboratory testing (complete blood count, urinalysis, and biochemical blood testing) and dynamic renal scintigraphy to assess the secretory and evacuation functions of the renal tubular system. RESULTS: The laboratory tests revealed no abnormalities, including no hematuria or proteinuria, in either group. The Dhilum/Dstenosis and Vstenosis/Vhilum ratios varied from 2.8 to 5.2 and from 2.9 to 8.3, respectively, and did not differ between the symptomatic and asymptomatic patients. All 40 patients with LRV compression stenosis were diagnosed with left gonadal vein reflux with a mean duration of 4.7 ± 0.6 seconds and 2.2 ± 0.6 seconds in the symptomatic and asymptomatic patients, respectively (P = .005). Eight patients had signs of NS on DUS, including five in the symptomatic group (SMA angle, 34.8° ± 2.7°; Dhilum/Dstenosis ratio, 5.2 ± 0.2; and Vstenosis/Vhilum ratio, 5.7 ± 0.4) and three in the asymptomatic group (SMA angle, 35° ± 2.8°; Dhilum/Dstenosis ratio, 5; and Vstenosis/Vhilum ratio, 5 ± 0.5). The groups did not differ significantly in the DUS parameters. Scintigraphy did not reveal any cases of secretory or evacuation dysfunction of the left kidney, including in the patients with DUS signs of NS. The maximum uptake time, elimination half-life, and effective renal plasma flow were within the normal ranges. CONCLUSIONS: LRV compression stenosis without hematuria has no significant effects on the functional state of the left kidney, irrespective of the disease severity. In patients with PeVDs, dynamic renal scintigraphy provides an objective assessment of left kidney function.


Subject(s)
Renal Veins , Vascular Diseases , Humans , Female , Renal Veins/diagnostic imaging , Constriction, Pathologic , Functional Status , Vascular Diseases/complications , Vascular Diseases/diagnostic imaging , Kidney/diagnostic imaging , Pelvic Pain , Hematuria/etiology
15.
Pediatr Nephrol ; 39(3): 799-806, 2024 Mar.
Article in English | MEDLINE | ID: mdl-37733097

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.


Subject(s)
Hematuria , Renal Nutcracker Syndrome , Female , Adolescent , Humans , Child , Follow-Up Studies , Hematuria/diagnosis , Hematuria/etiology , Retrospective Studies , Ultrasonography , Renal Nutcracker Syndrome/diagnosis , Renal Nutcracker Syndrome/diagnostic imaging , Renal Veins/diagnostic imaging , Proteinuria/diagnosis , Proteinuria/etiology , Proteinuria/therapy
17.
Nephrol Ther ; 19(7): 1-6, 2023 12 20.
Article in French | MEDLINE | ID: mdl-38073241

ABSTRACT

Late thrombosis of the renal graft vein is a rare complication that results in graft loss in the majority of cases. We describe the case of a 57-year-old female patient who had a kidney transplant 32 years ago and developed a late thrombosis of the graft vein, accompanied by extensive thrombosis in the common femoral and iliac veins. Risk factors included severe malnutrition, chronic inflammation due to an anal fistula, and Cockett syndrome. The treatment consisted of mechanical thrombectomy of the iliac vein, placement of a stent in the common iliac vein, partial thromboaspiration of the renal vein thrombus with local thrombolysis, followed by systemic anticoagulation. With this approach, renal function fully recovered without major complications.


La thrombose tardive de la veine du greffon rénal est une complication rare qui conduit à la perte du greffon dans la majorité des cas. Nous présentons le cas d'une femme de 57 ans, transplantée depuis 32 ans, qui a développé une thrombose de la veine du greffon, se manifestant par une insuffisance rénale aiguë anurique. Cette thrombose compliquait une thrombose extensive débutant dans la veine fémorale superficielle et s'étendant dans les veines fémorale commune et iliaque. La patiente présentait plusieurs facteurs de risque de thrombose veineuse, tels qu'un état de malnutrition sévère, une inflammation chronique due à une fistule anale chronique et un syndrome de Cockett. La patiente a été traitée en plusieurs étapes successives : une thrombectomie mécanique de toute la veine iliaque a d'abord été réalisée, suivie de la mise en place d'un stent dans la veine iliaque commune gauche en raison du syndrome de Cockett, puis d'une thrombo-aspiration partielle du thrombus de la veine rénale combinée à une thrombolyse locale (par urokinase) de la veine rénale via un cathéter, et enfin d'une anticoagulation systémique. Cette approche a permis une récupération complète de la fonction rénale sans complication notable. Nous rapportons cette prise en charge in situ d'une thrombose tardive de la veine d'un greffon rénal chez une patiente avec un syndrome de Cockett, ayant permis une issue favorable.


Subject(s)
May-Thurner Syndrome , Thrombosis , Female , Humans , Middle Aged , May-Thurner Syndrome/complications , May-Thurner Syndrome/therapy , Renal Veins/diagnostic imaging , Thrombosis/etiology , Iliac Vein/diagnostic imaging , Kidney , Treatment Outcome
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