ESPN 51th Annual Meeting

ESPN 2018


 
Can Pediatric Orthostatic Proteinuria be a manifestation of Nutcracker syndrome?
TERESA PAPALIA 1 ROSITA GRECO 1 FRANCESCO MOLLICA 1 AGATA MOLLICA 1 RENZO BONOFIGLIO 1

1- NEPHROLOGY DIALYSIS AND TRANSPLANTATION DEPARTMENT. ANNUNZIATA HOSPITAL. COSENZA-ITALY.
 
Introduction:

The cause of orthostatic proteinuria is not clear but may often relate to obstruction of the left renal vein in the fork between the aorta and the superior mesenteric artery (= renal nutcracker). Prevalence of NCP is unknown and the clinical manifestations are various. We present two cases of nutcracker syndrome to underline the importance of the study of renal vasculature in patients with non-contributory clinical and laboratory data.

Material and methods:

Case 1: A 8-year-old girl was referred for the evaluation of proteinuria. She was asymptomatic. Physical examination and laboratory findings were entirely normal except orthostatic proteinuria. Case 2: A 12-year-old boy was referred for the evaluation of proteinuria.  Physical examination and laboratory data  were entirely normal except orthostatic proteinuria.

Results:

In both cases, Doppler ultrasound indicated normal-sized kidneysbut abruptly narrowed left renal vein between aorta and vertebra, which was the characteristic feature of posterior nutcracker syndrome.

Conclusions:

In children with postural proteinuria, if any apparent cause is not proved, nutcracker syndrome should be suspected as the most common and benign cause of postural proteinuria. Renal Doppler ultrasound may be a useful method in screening  nutcracker syndrome among patients with orthostatic proteinuria.