Pediatric Department, Hadhramout University College of Medicine, Mukalla, Hadhramout governorate, Yemen.
Neuropsychiatry clinic, Mukalla, Hadhramout governorate, Yemen.
BMC Nephrol. 2019 Sep 5;20(1):349. doi: 10.1186/s12882-019-1508-6.
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.
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.
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.
胡桃夹综合征是儿童血尿易被忽视的原因。其特征为左肾静脉在腹主动脉和肠系膜上动脉之间受压，导致肾静脉高压。间歇性血尿和直立性蛋白尿，伴或不伴有腹痛或侧腰痛是常见的临床表现。由于存在多变的非特异性症状和非明显的体格检查结果，导致诊断延迟。
我们介绍一位十岁女孩，自两岁起出现四次无痛性肉眼血尿和反复镜下血尿。多普勒超声显示左肾静脉受压，3D 计算机断层血管造影证实为前胡桃夹。患者接受保守治疗，包括营养支持（Pediasure 完全配方和高热量食物）、铁补充剂，并进行随访，监测贫血、高血压和肾功能不全。
胡桃夹综合征是儿童反复发生肉眼血尿的罕见原因。需要高度怀疑和适当的影像学检查以做出正确诊断，避免给家庭带来心理和经济压力。
