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Open AccessArticle

Degree of Left Renal Vein Compression Predicts Nutcracker Syndrome

Department of General Surgery, Mayo Clinic, Phoenix, AZ 85054, USA
Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Phoenix, AZ 85054, USA
Tufts University School of Medicine, Boston, MA 02111, USA
Mayo Clinic School of Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA
Division of Interventional Radiology, Department of Radiology, University of Utah, Salt Lake City, UT 84112, USA
Author to whom correspondence should be addressed.
J. Clin. Med. 2018, 7(5), 107;
Received: 31 March 2018 / Revised: 2 May 2018 / Accepted: 3 May 2018 / Published: 8 May 2018
(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)
Nutcracker syndrome (NS) refers to symptomatic compression of the left renal vein (LRV) between the abdominal aorta and superior mesenteric artery with potential symptoms including hematuria, proteinuria, left flank pain, and renal venous hypertension. No consensus diagnostic criteria exist to guide endovascular treatment. We aimed to evaluate the specificity of LRV compression to NS symptoms through a retrospective study including 33 NS and 103 control patients. The size of the patent lumen at point of compression and normal portions of the LRV were measured for all patients. Multiple logistic regression analyses (MLR) assessing impact of compression, body mass index (BMI), age, and gender on the likelihood of each symptom with NS were obtained. NS patients presented most commonly with abdominal pain (72.7%), followed by hematuria (57.6%), proteinuria (39.4%), and left flank pain (30.3%). These symptoms were more commonly seen than in the control group at 10.6, 11.7, 6.8, and 1.9%, respectively. The degree of LRV compression for NS was 74.5% and 25.2% for controls (p < 0.0001). Higher compression led to more hematuria (p < 0.0013), abdominal pain (p < 0.006), and more proteinuria (p < 0.002). Furthermore, the average BMI of NS patients was 21.4 and 27.2 for controls (p < 0.001) and a low BMI led to more abdominal pain (p < 0.005). These results demonstrate a strong correlation between the degree of LRV compression on imaging in diagnosing NS. View Full-Text
Keywords: nutcracker syndrome; left renal vein; compression nutcracker syndrome; left renal vein; compression
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Hangge, P.T.; Gupta, N.; Khurana, A.; Quencer, K.B.; Albadawi, H.; Alzubaidi, S.J.; Knuttinen, M.-G.; Naidu, S.G.; Oklu, R. Degree of Left Renal Vein Compression Predicts Nutcracker Syndrome. J. Clin. Med. 2018, 7, 107.

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