ABSTRACT
Several renal vascular pathological processes have been associated with hematuria.
These include renal artery aneurysm (RAA), fibromuscular dysplasia (FMD), renal nutcracker
syndrome (RNS), renal arteriovenous malformation, renal vasculitis, and renal artery
or vein thrombosis. We present an unusual case of hematuria in a patient eventually
diagnosed with RAA, FMD, and RNS. Percutaneous therapy, including endovascular coiling,
percutaneous transluminal angioplasty, and stent placement were used to address the
underlying pathology. The differential diagnosis, pathophysiology, and surgical and
interventional management of these renal vascular disorders are reviewed.
KEYWORDS
Hematuria - fibromuscular dysplasia - nutcracker syndrome - renal artery aneurysm
- vasculitis - coil - angioplasty - stent
REFERENCES
- 1
El Kharras A, Salaheddine T, Aziz N, Jidal M, Chaouir S, Benameur M.
A rare cause of hematuria: rupture of a renal artery aneurysm-a case report.
J Radiol.
2005;
86
954-956
- 2
Romero-Teran O, Torres-Contreras L M, Mora-Fol J R, Andrade-Sepulveda V R, Baeza-Herrera C.
Calcified renal artery aneurism and high blood pressure: a case report and review
of the literature [in Spanish].
Cir Cir.
2004;
72
217-220
- 3
Barbey F, Matthieu C, Nseir G, Burnier M, Teta D.
A young man with a renal colic.
J Intern Med.
2003;
254
605-608
- 4
Shaper K R, Jackson J E, Williams G.
The nutcracker syndrome: an uncommon cause of haematuria.
Br J Urol.
1994;
74
144-146
- 5
Grossfeld G D, Litwin M S, Wolf J S et al..
Evaluation of asymptomatic microscopic hematuria in adults: the American Urological
Association best practice policy-part I: definition, detection, prevalence, and etiology.
Urology.
2001;
57
599-603
- 6
Mazhari R, Kimmel P L.
Hematuria: an algorithmic approach to finding the cause.
Cleve Clin J Med.
2002;
69
870-876
- 7 Grant J CB. Methods of Anatomy. Baltimore; Williams & Wilkins 1937: 158
- 8
Buschi A J, Harrison R B, Norman A et al..
Distended left renal vein: CT/sonographic normal variant.
AJR Am J Roentgenol.
1980;
135
339-342
- 9
Macmahon H E, Latorraca R.
Essential renal hematuria.
J Urol.
1954;
71
667-676
- 10
Ekim M, Ozcakar Z B, Fitoz S et al..
The “nutcracker phenomenon” with orthostatic proteinuria: case reports.
Clin Nephrol.
2006;
65
280-283
- 11
Takemura T, Iwasa H, Yamamoto S et al..
Clinical and radiological features in four adolescents with nutcracker syndrome.
Pediatr Nephrol.
2000;
14
1002-1005
- 12
De Schepper A.
“Nutcracker” phenomenon of the renal vein and venous pathology of the left kidney.
J Belge Radiol.
1972;
55
507-511
- 13
Cheon J E, Kim W S, Kim I O et al..
Nutcracker syndrome in children with gross haematuria: Doppler sonographic evaluation
of the left renal vein.
Pediatr Radiol.
2006;
36
682-686
- 14
Hohenfellner M, Steinbach F, Schultz-Lampel D et al..
The nutcracker syndrome: new aspects of pathophysiology, diagnosis and treatment.
J Urol.
1991;
146
685-688
- 15
Nishimura Y, Fushiki M, Yoshida M et al..
Left renal vein hypertension in patients with left renal bleeding of unknown origin.
Radiology.
1986;
160
663-667
- 16
Ahmed K, Sampath R, Khan M S.
Current trends in the diagnosis and management of renal nutcracker syndrome: a review.
Eur J Vasc Endovasc Surg.
2006;
31
410-416
- 17
Hohenfellner M, D'Elia G, Hampel C, Dahms S, Thuroff J W.
Transposition of the left renal vein for treatment of the nutcracker phenomenon: long-term
follow-up.
Urology.
2002;
59
354-357
- 18
Rudloff U, Holmes R J, Prem J T, Faust G R, Moldwin R, Siegel D.
Mesoaortic compression of the left renal vein (nutcracker syndrome): case reports
and review of the literature.
Ann Vasc Surg.
2006;
20
120-129
- 19
Tanaka H, Waga S.
Spontaneous remission of persistent severe hematuria in an adolescent with nutcracker
syndrome: seven years' observation.
Clin Exp Nephrol.
2004;
8
68-70
- 20
Segawa N, Azuma H, Iwamoto Y et al..
Expandable metallic stent placement for nutcracker phenomenon.
Urology.
1999;
53
631-633
- 21
Yu G, Bo S.
The nutcracker syndrome.
J Urol.
2003;
169
2293-2294
- 22
Oteki T, Nagase S, Hirayama A et al..
Nutcracker syndrome associated with severe anemia and mild proteinuria.
Clin Nephrol.
2004;
62
62-65
- 23
Neste M G, Narasimham D L, Belcher K K.
Endovascular stent placement as a treatment for renal venous hypertension.
J Vasc Interv Radiol.
1996;
7
859-861
- 24
Shin J I, Park J M, Lee S M et al..
Factors affecting spontaneous resolution of hematuria in childhood nutcracker syndrome.
Pediatr Nephrol.
2005;
20
609-613
- 25
Hartung O, Grisoli D, Boufi M et al..
Endovascular stenting in the treatment of pelvic vein congestion caused by nutcracker
syndrome: lessons learned from the first five cases.
J Vasc Surg.
2005;
42
275-280
- 26
Scultetus A H, Villavicencio J L, Gillespie D L.
The nutcracker syndrome: its role in the pelvic venous disorders.
J Vasc Surg.
2001;
34
812-819
- 27
Park Y B, Lim S H, Ahn J H et al..
Nutcracker syndrome: intravascular stenting approach.
Nephrol Dial Transplant.
2000;
15
99-101
- 28
Lin W Q, Huang H F, Li M et al..
Diagnosis and therapy of the nutcracker phenomenon: long-term follow-up.
Zhonghua Wai Ke Za Zhi.
2003;
41
889-892
- 29
Stanley J C, Rhodes E L, Gewertz B L, Chang C Y, Walter J F, Fry W J.
Renal artery aneurysms: significance of macroaneurysms exclusive of dissections and
fibrodysplastic mural dilations.
Arch Surg.
1975;
110
1327-1333
- 30
Henke P K, Cardneau J D, Welling III T H et al..
Renal artery aneurysms: a 35-year clinical experience with 252 aneurysms in 168 patients.
Ann Surg.
2001;
234
454-462
- 31
Ishizuka O, Takayama F, Sone S.
Large renal aneurysm successfully treated by percutaneous embolization using detachable
steel coils.
Int J Urol.
2006;
13
993-994
- 32
Klein G E, Szolar D H, Breinl E, Raith J, Schreyer H H.
Endovascular treatment of renal artery aneurysms with conventional non-detachable
microcoils and Guglielmi detachable coils.
Br J Urol.
1997;
79
852-860
- 33
Trocciola S M, Chaer R A, Lin S C et al..
Embolization of renal artery aneurysm and arteriovenous fistula: a case report.
Vasc Endovascular Surg.
2005;
39
525-529
- 34
Birrer M, Do D D, Mahler F, Triller J, Baumgartner I.
Treatment of renal artery fibromuscular dysplasia with balloon angioplasty: a prospective
follow-up study.
Eur J Vasc Endovasc Surg.
2002;
23
146-152
- 35
Tegtmeyer C J, Selby J B, Hartwell G D, Ayers C, Tegtmeyer V.
Results and complications of angioplasty in fibromuscular disease.
Circulation.
1991;
83
I155-I161
- 36
Sueyoshi E, Sakamoto I, Hayashi N et al..
Ruptured renal artery aneurysm due to Behcet's disease.
Abdom Imaging.
1996;
21
166-167
- 37
Planer D, Verstandig A, Chajek-Shaul T.
Transcatheter embolization of renal artery aneurysm in Behcet's disease.
Vasc Med.
2001;
6
109-112
- 38
Park J H, Han M C, Kim S H, Oh B H, Park Y B, Seo J D.
Takayasu arteritis: angiographic findings and results of angioplasty.
AJR Am J Roentgenol.
1989;
153
1069-1074
- 39
Kim H S, Fine D M, Atta M G.
Catheter-directed thrombectomy and thrombolysis for acute renal vein thrombosis.
J Vasc Interv Radiol.
2006;
17
815-822
Gregory J DubelM.D.
Division of Interventional Radiology, Rhode Island Hospital
593 Eddy Street, 3rd Floor Main Building, Providence, RI 02903
