RESUMO
BACKGROUND: Nutcracker syndrome is an easily missed cause of hematuria in children. It is characterized by left renal vein entrapment between the abdominal aorta and the superior mesenteric artery causing renal venous hypertension. Intermittent hematuria and orthostatic proteinuria with or without abdominal or flank pain are the common clinical manifestations. Presence of variable non-specific symptoms and non-significant physical findings results in a delayed diagnosis. CASE PRESENTATION: We present a ten -year -old girl with four episodes of painless gross hematuria and recurrent microscopic hematuria since the age of two years. Doppler ultrasound showed left renal vein compression while 3 D computerized tomography angiography confirmed the diagnosis of an anterior nutcracker. The patient was conservatively treated with nutritional support (pediasure complete formula and high calorie food), iron supplements and followed up, monitored for anemia, hypertension and renal insufficiency. CONCLUSION: Nutcracker syndrome is a rare cause of recurrent gross hematuria in children. A high index of suspicion and proper imaging is needed to reach a proper diagnosis and avoid the psychological and financial stress on the family.
Assuntos
Hematúria/complicações , Hematúria/diagnóstico por imagem , Diagnóstico Ausente , Síndrome do Quebra-Nozes/complicações , Síndrome do Quebra-Nozes/diagnóstico por imagem , Criança , Feminino , Hematúria/metabolismo , Humanos , Recidiva , Síndrome do Quebra-Nozes/metabolismoRESUMO
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Assuntos
Humanos , Feminino , Adulto Jovem , Aterosclerose/metabolismo , Aterosclerose/patologia , Dor Abdominal/metabolismo , Síndrome do Quebra-Nozes/patologia , Isquemia Mesentérica/diagnóstico , Aterosclerose/complicações , Aterosclerose/diagnóstico , Dor Abdominal/complicações , Síndrome do Quebra-Nozes/metabolismo , Isquemia Mesentérica/complicaçõesRESUMO
La hematuria recidivante unilateral supone un reto diagnóstico y terapéutico para el urólogo. El hemangioma renal (HR) figura entre las posibles causas. La localización en la papila renal es típica. Se presenta un caso de hematuria secundaria a HR que fue diagnosticado en primera instancia como síndrome del cascanueces. Tras una revaloración se realizó ureterorrenoscopia que demostró un hemangioma papilar sangrante. La lesión fue tratada con fotovaporización láser con buen resultado. Se revisa la etiopatogenia, diagnóstico y las opciones terapéuticas frente al HR sangrante (AU)
Unilateral recurrent hematuria is a diagnostic and therapeutic challenge for the urologist. The renal hemangioma (RH) is a possible cause. The location is typically the renal papilla. A case of hematuria secondary to RH who was diagnosed at first instance and nutcracker syndrome is presented. After a diagnostic reassessment ureterorenoscopy was performed which showed a bleeding papillary hemangioma. The lesion was treated with laser PVP with good results. The pathogenesis, diagnosis and therapeutic options against the bloody RH is reviewed (AU)
