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o you know what the Nutcracker Syndrome is? Why does it cause so many health problems?
Nutcracker Syndrome (NCS) is a health condition caused by compression of the left renal vein (LRV) between the abdominal aorta (AA) and the superior mesenteric artery (SMA). This unique name comes from its anatomical location, imagining that the SMA and AA are like a nutcracker clamping a nut, causing compression of the renal vein. To date, the clinical manifestations of this disease have not been clearly defined in terms of diagnostic criteria, resulting in delayed or misdiagnosed diagnosis for many patients.
Nutcracker syndrome was first clinically reported in 1950, and its signs and symptoms are usually related to obstruction of the outflow of the left renal vein.
Symptoms and Signs
The symptoms of NCS vary, mainly manifested as drainage obstruction due to renal vein compression. This can cause renal venous hypertension, resulting in hematuria (which may cause anemia) and abdominal pain (especially left-sided flank or pelvic pain). These abdominal pains may be improved or worsened by the patient's posture.
In addition, patients may develop postural proteinuria, meaning that the amount of protein in the urine varies depending on whether the patient is sitting or standing. Since the left genital vein is also dependent on the left renal vein for drainage, men may experience pain in the left testicle, and women may experience pain in the left lower abdomen during sexual intercourse or menstruation.
Occasionally, patients experience abdominal swelling and pain, which is related to compression of the mesenteric veins, and NCS can lead to varicose veins and varicose veins in the lower limbs.
Causes
In normal anatomy, the left renal vein should be located between the SMA and AA. However, when the left renal vein is located behind the AA or in front of the spine, NCS may occur. NCS can be classified according to the course of the left renal vein into anterior NCS and posterior NCS, but the most common cause is still the entrapment of the abdominal aorta and the superior mesenteric artery.
Diagnostic Methods
Nutcracker syndrome is usually diagnosed using imaging tests, including Doppler ultrasound (DUS), computed tomography (CT), magnetic resonance imaging (MRI), and venography. DUS is usually the initial investigation of choice based on suspected symptoms.
DUS provides 95% to 100% specificity, but it should be noted that patient positioning can affect the results.
Treatment Options
Treatment of NCS depends on the severity and symptoms of the condition and can include conservative management and surgical intervention.
Conservative management
Conservative management is preferred, especially in pediatric patients, as hypertension will improve with growth. This situation will promote more weight gain to reduce the pressure on the veins.
Surgical Management
Surgical options include venous switch, venous bypass, and kidney autotransplantation. The appropriate surgical option is chosen based on the patient's symptoms and the physician's advice. Experience shows that most patients who undergo surgery experience improvement in symptoms 70 months after surgery.
ConclusionAlthough medical treatment is simple, surgical intervention is often an inevitable choice for patients with severe symptoms.
Nutcracker syndrome is a complex and difficult to diagnose disorder that can have a serious impact on the patient's quality of life. As our understanding of this disease improves, future diagnosis and treatment may become more precise and effective. When facing such health challenges, how do you view the importance of paying attention to and paying attention to your own health?
