nutcracker syndrome

Nutcracker syndrome: symptoms, causes and treatment

Our body is an organism of high complexity, made up of an enormous quantity of systems that operate in unison to allow us to survive. However, sometimes these systems may become damaged, fail or see their functionality altered or reduced by an injury or illness.

Regarding the latter, some are more or less frequent and known, while in other cases we find strange and unusual situations of which there is at least scarce knowledge due to its low prevalence.

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

Nutcracker syndrome: what is it?

It is called nutcracker syndrome or nutcracker syndrome, a rare kidney disease that arises due to the compression of the left renal vein by the blood vessels surrounding it and / or other parts of the body.

This compression generates the imprisonment and stenosis of the renal vein, something that greatly increases the pressure in said vein. This in turn facilitates the appearance of internal fistulas and renal bleeding.

symptom

This syndrome sometimes appears asymptomatically, but the presence of symptomatology at the level of the genitourinary system is often observed . Specifically, it is common for gross hematuria to appear at the macroscopic level, meaning that reddish urine appears when blood is also expelled during urination. There are also internal varicose and leg varicose veins, as well as pelvic congestion.

It is not uncommon for lumbar pain to appear unilaterally , a discomfort whose intensity can be very variable depending on the case. In addition in the case of women may appear dysmenorrhea or dysregulation of the menstrual cycle.

Occasionally, dispaurenia or pain is observed during intercourse, and it can also generate alterations at an emotional level. Proteinuria can also be observed, or protein excretion through the urine, especially in young people.

Although it is a disease that tends to be benign and does not generate major complications (in fact, the prognosis is almost always very good), the fact is that complications can sometimes appear at the kidney level that can compromise life or become very invalidating. For example, if recurrent and regular bleeding occurs it is easy to fall into anemia, it is possible that nephropathies appear and blood pressure and blood pressure can be dangerously altered.

It is an alteration that can appear at any age and regardless of sex, although it is more frequent in women . It is also more frequent in the third and fourth decades of life, and according to the available literature is more prevalent in the population from the Far East.

Basic types

The nutcracker syndrome can occur in different ways , highlighting the following as the most common (and especially the first).

Previous nutcracker syndrome

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

Later nutcracker syndrome

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

Combined nutcracker syndrome

On this occasion, rare, it is the case that the left renal vein is pinched in its anterior branch by the two arteries while the posterior one does the same between the aorta and the vertebral column.

Causes

As we have seen, the nutcracker syndrome is an alteration caused when the aorta and superior mesenteric arteries pinch and compress the left renal vein, just as a nutcracker would with the dried fruit (in fact, hence its name) .

The symptomatology appears when the level of pressure in the renal vein increases, damaging the septa between veins and the renal apparatus and entering the blood in the urine . In turn, this would cause a venous circulation to emerge towards territories such as the gonadal (something that would influence genital and sexual symptoms) and the urethra.

The reason for this impingement is not clear, but it can be caused by alterations at the embryonic level. Although it is more common in the population of the Far East, it has not been proven that there is a relationship with genetic inheritance , the majority of cases being sporadic. In the case of children, it can sometimes occur in the face of bodily changes (which do not occur proportionally throughout the body) typical of growth.

In adults, some of the possible hypotheses in this regard suggest that it could be caused by abnormalities such as duplications of the renal vein, the presence of tumors or inflammations that push the arteries in such a way that they compress the left renal vein, an excessively low body mass ( the fat present in this area facilitates the existence of more space between both arteries), hyperlordosis or problems related to the position of the kidneys during postural changes.

Treatment

As we have seen previously, the nutcracker syndrome is usually benign, although it can sometimes be a threat to the life of the affected person .

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

Among the most frequent and recommended is the implantation of an intravascular or extravascular stent , a device that keeps the affected vessel open. In cases of severe renal bleeding (visible in hematuria), blood transfusions and other interventions may be necessary to preserve the state of health and maintenance of the constants. A kidney auto-transplant or a by-pass in the renal vein may be necessary.

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