Nutcracker syndrome: symptoms, causes and treatment

Our body is a very complex organism, made up of a large number of systems that work in unison to enable us to survive. However, sometimes these systems can become damaged, fail, or have their functionality altered or reduced due to injury or illness.

As for the latter, some are more or less frequent and well known, while in other cases we find strange and unusual situations of which we are less aware due to their low prevalence.

An example of a rare and rare disease can be found in the so-called nutcracker syndrome, kidney and vascular disease which we will talk about throughout this article.

    Nutcracker syndrome: what is it?

    This is called Nutcracker Syndrome or a rare kidney disease that occurs. due to compression of the left renal vein by the blood vessels surrounding it and / or other parts of the body.

    This compression generates entrapment and stenosis of the renal vein, which results in a sharp increase in pressure in this vein. This in turn facilitates the onset of internal fistulas and kidney bleeding.

    symptoms

    This syndrome sometimes appears asymptomatically, however the presence of symptoms in the genitourinary system is often observed. Specifically, it is common for hematuria to appear macroscopically visible, that is, red urine to appear when blood is also expelled during urination. Internal varicose veins and legs also appear, as well as pelvic congestion.

    It is not uncommon for this to appear unilateral low back pain, A discomfort whose intensity can be very variable depending on the case. In addition, in women, dysmenorrhea or menstrual cycle dysregulation may occur.

    Dyspareunia or pain is sometimes seen during sex and can also lead to emotional disturbances. You may also observe proteinuria or expulsion of protein through the urine, especially in young people.

    Even though it is an illness that tends to be mild and do not cause major complications (in fact, the prognosis is almost always very good), the truth is that sometimes complications can appear in the kidney which can be life threatening or become very debilitating. For example, if recurrent and regular bleeding occurs, it is easy to fall into anemia, kidney disease can occur, and it can dangerously alter blood and blood pressure.

    It is an alteration which it can appear at any age and regardless of gender, although it is more common in women. It is also more common in the third and fourth decades of life and, according to the available literature, it is more common in the Far Eastern population.

      basic types

      Nutcracker syndrome can occur in different ways, Highlighting as the most common the following elements (and in particular the first).

      Previous nutcracker syndrome

      The most common form of this syndrome occurs when compression of the left renal vein occurs by the aortic and mesenteric arteries.

      Posterior nutcracker syndrome

      Unlike the previous case, in posterior-type nutcracker syndrome, the renal vein is trapped and compressed. between one of the two arteries and the spine. The associated effects and symptoms are generally the same.

      Combined nutcracker syndrome

      On this rare occasion, the left renal vein is pinched in its anterior branch by the two arteries while the posterior vein does the same between the aorta and the spine.

      the causes

      As we have seen, nutcracker syndrome is an alteration that occurs when the aortic artery and the superior mesenteric artery pinch and compress the left renal vein, like a nutcracker with walnuts (in fact, hence its name).

      Symptoms appear when the pressure level in the renal vein increases, damage the septa between the veins and the kidney tract and get blood in the urine. In turn, this would cause venous circulation to areas such as the gonads (which would influence genital and sexual symptoms) and the urethra.

      The reason for this pinching is not clear, but it may be caused by alterations at the embryonic level. Although it is more common in the Far Eastern population, it has not been proven to be related to genetic inheritance, Being the majority of sporadic cases. In the case of children, it can sometimes occur in the face of bodily changes (which do not occur in proportion to the whole body) of growth.

      In adults, some of the possible hypotheses in this regard suggest that it could be caused by abnormalities such as duplicate renal vein, presence of tumors or inflammation that push the arteries in such a way as to compress the left renal vein, too little body mass (the fat in this area makes more space between the two arteries easier), hyperlordosis or problems with the position of the kidneys during changes posture.

      treatment

      As we saw above, nutcracker syndrome is generally a mild behavior, although it can sometimes pose a threat to the life of the affected person.

      Sometimes this condition may not require treatment beyond monitoring, observation and control of the patient’s condition, but in others it will be necessary to perform some type of intervention, usually surgical.

      Among the most common and recommended, there are implantation of an intravascular or extravascular stent, A device that keeps the affected vessel open. In case of severe renal hemorrhage (visible in hematuria), blood transfusions and other interventions may be necessary to maintain the condition and keep things constant. Kidney self-transplantation or renal vein bypass surgery may be necessary.

      Bibliographical references:

      • Chen, YM, Wang, IK, Ng, KK, Huang, CC (2002). Nutcracker Syndrome: an unknown cause of hematuria. Chang Gung Med J., 25 (10): 700-705.
      • Gulleroglu, K., Gulleroglu, B. and Baskin, E. (2014). Nutcracker syndrome. World J Nephrol., 3 (4): 277-281.
      • Hermida Pérez, JA (2016). Nutcracker syndrome. General and Family Medicine, 5 (1): 21-24.
      • Martínez-Salamanca García, JI, Herranz Amo, F., Gordillo Gutiérrez, I. Díez Be, JM, Pujarà Rius, D., Castaño González, I., Moralejo Gárate, M., Cabell Benavente, R. & Hernández Fernández, C. (2004). Nutcracker or nutcracker syndrome: demonstration by helical computed tomography with 3D reconstruction (VR). Spanish urological acts, 28 (7).
      • National Center for Advancing Translational Sciences (sf) Nutcracker kidney syndrome. Information Center for Genetic and Rare Diseases [Online]. Available at: https://rarediseases.info.nih.gov/espanol/13285/sindrome-renal-del-cascanueces.

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