Información adicional
- Num_publicacion 78/3-4)
-
Resumen_ingles
Introduction: This syndrome defines the compression of the left renal vein between the aorta and the superior mesenteric artery, causing an elevated pressure of said renal vein with possible development of collateral veins. Clinically, intermittent hematuria, proteinuria appears with or without abdominal pain or in the left abdomen.
Clinical cases: We present 15 children between 7 and 13 years old. Most with normal physical and clinical examination of abdominal or left flank pain with normal blood pressure (46.6%); urinary findings: non-glomerular hematuria (20%) and non-nephrotic range proteinuria (20%), with microalbumin less than 300 mg in 24-hour urine. One patient (6.7%) presented proteinuria associated with glucosuria and hypertension. Doppler ultrasound measurements of the anteroposterior diameter (AP) and the maximum velocities of the left renal vein are diagnostic: dilatation and slowing of the flow proximal to the aortomesenteric clamp, decrease in caliber with accelerated flow at the distal level and angle of the clamp less than 30º. In two cases, angio-TAC was required, showing the compressed left renal vein between the aorta and the superior mesenteric artery. MR angiography offers excellent anatomical definition. The treatment is conservative. Treatment with angiotensin-converting enzyme inhibitors, surgery, or extravascular procedures may be necessary.
Conclusion: Suspect RVS, in the presence of hematuria, proteinuria, recurrent abdominal pain, a diagnosis that requires a high index of suspicion. Requires ultrasound. In selected cases, CT angiography, MRI or phlebography, the latter being the gold standard for diagnosis, which is not usually required.
- Palabras_clave_ingles Nutcracker syndrome renal vein hypertension syndrome aortomesenteric gorge syndrome hematuria proteinuria orthostatic proteinuria
- Todos_autores E. Pérez González1, V. Cantos Pastor1, M. Guido Ferrera2, M. Marin Patón1, A. Rangel Villalobos3
- autores listados E. Pérez González, V. Cantos Pastor, M. Guido Ferrera, M. Marin Patón, A. Rangel Villalobos
- Titulo_ingles Recurrent hematuria as a guiding symptom of aortomesenteric gorge syndrome
- Centros_trabajo 1Servicio de Pediatría. Hospital Universitario Virgen Macarena. Sevilla. 2Hospital Quirón. Sevilla. 3UGC Radiodiagnóstico. Hospital Universitario Virgen Macarena. Sevilla
- Publicado en Acta Pediatr Esp. 2020; 78(3-4): e136-e140
- copyright ©2020 Ediciones Mayo, S.A.
- Tipo de Artículo Clínico (Microdatos) Case Reports