A 21-year-old woman was found to have had hematuria and proteinuria for 5 years. After she was referred to our hospital, her laboratory findings showed urinary red blood cells (RBCs)>100/high-powered field without any dysmorphic RBCs and proteinuria (0.66 g/g-creatinine) without renal dysfunction. Furthermore, increased brightness at her renal cortex was confirmed on abdominal ultrasonography. Chronic proliferative glomerulonephritis (CGN) was highly suspected; therefore, a renal biopsy was performed. Her pathological findings showed no abnormality, and contrast-enhanced abdominal computed tomography revealed left renal vein compression (Picture A) with ovarian vein varices (Picture B). Therefore, we diagnosed the patient to have nutcracker syndrome with pelvic congestion.
Picture.
This disease is rare (1). Although a renal biopsy might have been unnecessary in this case, her clinical manifestations mimicked those of CGN; furthermore, immunoglobulin A nephropathy with nutcracker syndrome has been reported (2). Therefore, although CGN was suspected, careful attention should be given to the possibility of nutcracker syndrome with pelvic congestion when encountering such cases.
The authors state that they have no Conflict of Interest (COI).
References
- 1. Inal M, Karadeniz Bilgili MY, Sahin S. Nutcracker syndrome accompanying pelvic congestion syndrome; color Doppler sonography and multiple CT finding: a case report. Iran J Radiol 11: e11075, 2014. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Imai N, Shirai S, Shibagaki Y, Kimura K. Nutcracker phenomenon in IgA nephropathy. Clin Kidney J 7: 325-326, 2014. [DOI] [PMC free article] [PubMed] [Google Scholar]