ESPN 51th Annual Meeting

ESPN 2018


 
Nutcracker syndrome detected in a adolescent boy with tubulointerstitial nephritis: Case report
EREN SOYALTIN 1 FATMA MUTLUBAS 1 SEÇIL ARSLANSOYU ÇAMLAR 1 CANER ALPARSLAN 1 DEMET ALAYGUT 1 ONDER YAVASCAN 1 BELDE KASAP DEMIR 2

1- IZMIR TEPECIK TRAINING AND RESEARCH HOSPITAL, PEDIATRIC NEPHROLOGY CLINIC, IZMIR , TURKEY
2- IZMIR KATIP CELEBI UNIVERSITY DEPARTMENT OF PEDIATRIC NEPHROLOGY AND RHEUMATOLOGY
 
Introduction:

 Tubulointerstitial nephritis (TIN) is a frequent cause of acute kidney injury (AKI). Patients often present with nonspecific symptoms, which can lead to delayed diagnosis and treatment of the disease. Etiology can be mostly drug-induced and infectious  in children. Nutcracker syndrome (NCS) describes left renal vein compression between the superior mesenteric artery and the aorta. Here we present a case of coexisting TIN and NCS. 

Material and methods:

 A 17-year-old male patient with a complaint of bloody urination and abdominal pain was admitted. It was learnt that he used nonsteroidal antiinflammatory drug as a pain reliever. There was no systemic disease. He  was normotensive and  no fever  on physical examination. In the laboratory evaluation, azotemia and hyperpotasemia (creatinine 1.8 mg / dL, K 5.6 mmol / L) were detected and hydration was started by accepting AKI. Hematuria and proteinuria were present in urine evaluation.Glomerular and tubular tests were requested to evaluate possible renal pathologies. Urine culture was steril. The complements level  were normal. There was nonnephrotic proteinuria and eosinophilia was seen in repeated urine analysis.The case was diagnosed as tubulointerstitial nephritis.In the imaging examinations, the renal ultrasonography was normal and the renal doppler showed retroperitoneal extension of the left renal vein and the distal / proximal diameter ratio was found to be 4. Case received TIN and concurrent NCS diagnosis. 

Results:

 Hematuria and flank  pain were associated with NCS. After hydration, creatinine level decreased to 1.3 mg / dl and the patient was discharged to the outpatient clinic.

Conclusions:

 NCS is although uncommon, it is an important diagnosis due to the important morbidity associated with it, including the risk of chronic kidney disease from long-term left renal vein (LRV) hypertension and the risk of LRV thrombosis. The cases use frequent analgesics for pain relief. This situation can also provide the basis for tubulointerstitial nephritis. Clinicians must be aware of these two conditions separately from each other.