Objective: The
aim of this study is to evaluate the clinical characteristics of pediatric
patients with Nutcracker syndrome and to determine whether there is a
relationship between clinical signs and left renal vein doppler ultrasonography
findings.

Materials and methods: Between
January 2015 and December 2018, clinical data of patients diagnosed with
Nutcracker syndrome were retrospectively reviewed. Patients were devided into two groups
as symptomatic (loin pain, macroscopic hematuria or both) and non-symptomatic
(incidentally detected microscopic hematuria and proteinuria), and the doppler
ultrasonography findings in both group were evaluated.

Results:
Fourty-one patients (28 female and 11 male patients, mean age 13,6±3,37
years) with the diagnosis of Nutcracker syndrome were included the study. Asymptomatic Nutcracker syndrome was found in 26
(63.4%) patients; in whom 46.1% were admitted for the evaluation of proteinuria
and 42.3% for isolated proteinuria. The most frequent symptoms were left flank
pain (33.3%), left flank pain and hematuria together (26.6%). The mean ratio of
the diameter of the hilar portion of the left renal vein to that of the
aortomesenteric portion was 5,07±1,02. The mean peak velocity ratio of the left renal vein aorta-mesenteric/hiler
portion was found to be 7,17±1,86. The peak velocity ratios of the LRV (p = 0.041)
were significantly higher in asymptomatic children with Nutcracker syndrome
than in the symptomatic group.

Conclusion:
The diagnosis of Nutcracker syndrome should be considered in the presence of
symptoms such as proteinuria and hematuria and should be absolutely ruled out
before attempting renal biopsy. In addition, our study showed that increased
compression of the left renal vein is mostly observed in proteinuria and
microscopic hematuria.

Keywords: Child, Doppler ultrasonography, Nutcracker syndrome