Abstract:

Nutcracker syndrome (NCS) is a clinical picture that occurs as a result of the pressure of the left kidney vein. The syndrome was first identified by Grantin in 1937. Most often, the left renal venus occurs as a result of a compression between the aorta and the superior mesenteric artery, and this type is defined as "anterior type". Less often, the "posterior NCS" can be seen as a result of the convulsion between the aorta and the vertebra of the retroaortic left renal venus. As a result of the pressure in the left renal venus blocking the blood flow, the pressure in the venus increases leading to the connectivity in the left kidney (1,2). Patients with Nutcracker syndrome can face many different clinical tables, ranging from asymptomatic hematury to heavy pelvic conjunction. Patients can apply to signs and findings such as hematuria, ortostatic proteinuria, side pain, abdominal pain, varicose, dysmenorrhea, impotence and fatigue. Rarely cases of Henoch-Schönlein purpura, IgA nefropathy, membranous nefropathy and nefrolithiasis are identified. Usually thin long-made and fat tissue is seen in few people. In literature it is stated that NCS patients are more than thought. This is due to the lack of awareness of this disease. However, the first and most important stage in the diagnosis of NCS is the suspicion of this syndrome (2,3). The diagnosis of Nutcracker syndrome can be placed with different imaging methods such as dopler ultrasound, CT anjiography, MR anjiography and retrograde left renal venography. Retrograd venography is preferred in severe cases because it is invasive, although it is the gold standard in the diagnosis of NCS. Doppler ultrasound is preferred first in patients with NCS suspicion because it is not invasive (3). Published in our magazine and arch. (4) In their studies between 2015 and 2018, they studied the relationship between the clinical symptoms of 41 patients they followed with the diagnosis of NCS, symptomatically and asymptomatically divided into two groups, and doppler ultrasound findings. In this study, they indicate that doppler ultrasound may be recommended as the first preferred method in these patients. They also emphasize that patients with isolated hematuria, proteinuria or left side pain should be diagnosed with NCS before a kidney biopsy (4).