Schöffel N, Liehr R-M, Bünger C, Krüger K, Rubin D
Klinik für Gastroenterologie und Diabetologie, Vivantes Humboldt-Klinikum, Am Nordgraben 2, 13509, Berlin, Deutschland.
Klinik für Gefäßmedizin, Vivantes Humboldt-Klinikum, Am Nordgraben 2, 13509, Berlin, Deutschland.
Internist (Berl). 2018 Jun;59(6):608-614. doi: 10.1007/s00108-017-0350-9.
We report about a 43-year-old woman with polyvalent drug addiction (i.e. alcohol, nicotine, methadone maintenance program with parallel consumption of heroin) who presented to the emergency department with peripheral edema, generalized weakness, and arthralgia. Laboratory findings revealed, among others, proteinuria, hyperlipoproteinemia and hypoproteinemia defining nephrotic syndrome. Computed tomography of the abdomen and iliocavography further revealed compression of left renal vein between aorta and superior mesenteric artery with distention of left ovarian vein as a possible cause of nephrotic syndrome (i. e. nutcracker syndrome). After excluding other possible causes of nephrotic syndrome, we decided against an interventional procedure due to poor compliance of the patient and potential risk of secondary stent dislocation. Instead, we opted for a surgical approach (i. e. veno-venous bypass, meaning transposition of left vena ovarica on vena cava inferior). The operative and postoperative course was uneventful. Postoperatively, proteinuria, microhematuria, arthralgia and edema receded.
我们报告了一名43岁的多药成瘾女性（即酒精、尼古丁成瘾，接受美沙酮维持治疗且同时使用海洛因），她因外周水肿、全身无力和关节痛就诊于急诊科。实验室检查结果显示，除其他异常外，蛋白尿、高脂蛋白血症和低蛋白血症确诊为肾病综合征。腹部计算机断层扫描和髂静脉造影进一步显示，左肾静脉在主动脉和肠系膜上动脉之间受压，左卵巢静脉扩张，这可能是肾病综合征（即胡桃夹综合征）的病因。在排除肾病综合征的其他可能病因后，由于患者依从性差以及继发支架移位的潜在风险，我们决定不采取介入手术。相反，我们选择了手术方法（即静脉-静脉搭桥术，即将左卵巢静脉转位至下腔静脉）。手术过程及术后恢复顺利。术后，蛋白尿、微量血尿、关节痛和水肿均消退。
