Can the Nutcracker heal itself?

The Nutcracker, also known as the Nutcracker Syndrome, is a disease of the human kidneys. It is mainly caused by changes in the veins on the kidneys, or when the veins on the kidneys are compressed. It can easily lead to decreased kidney function and poor blood flow in the renal veins. People with the Nutcracker need to be treated in time, and they will not heal on their own.

Can the Nutcracker heal itself ?

There is little hope for the Nutcracker to be cured. The patients are mainly tall and thin. The left renal vein is squeezed due to the angle formed by the abdominal aorta and the superior mesenteric artery, causing corresponding clinical symptoms such as proteinuria and hematuria. Especially after exercise. If it is not particularly serious, you don't need to worry too much. If it is serious, you can go to the hospital to consult a doctor to see if surgery is necessary.

Causes

Under normal circumstances, the left renal vein passes through the angle between the abdominal aorta and the superior mesenteric artery, crosses the front of the abdominal aorta and enters the inferior vena cava. This angle is approximately 45° to 60° and is filled with mesenteric fat, lymph nodes, peritoneum, and nerve fiber plexus, so that the left renal vein is not compressed. In patients with nutcracker syndrome, this angle is generally less than 16°.

Clinical manifestations

Most patients with Nutcracker syndrome present with hematuria with or without low back pain. Most patients are slender adolescents. Clinical manifestations include orthostatic proteinuria and left-sided varicocele in males. Some middle-aged and elderly women may present with hematuria and pelvic congestion syndrome.

diagnosis

The diagnosis of nutcracker syndrome is an exclusionary diagnosis, that is, typical clinical symptoms and auxiliary examinations can prove the existence of the "nutcracker" structure, while excluding other possible causes of clinical symptoms (such as tumors, stones, infections, malformations and glomerular diseases, etc.).

The most commonly recognized diagnostic indicators are :

1. The morphology of red blood cells in urine is non-glomerular (i.e. the proportion of normal red blood cell morphology in urine is >90%).

2. The ratio of calcium excretion in urine is normal (Ca/Cr (calcium/creatinine) <0.20).

3. Cystoscopy showed blood spurting from the left ureter (when macroscopic hematuria occurs).

4. Renal biopsy is normal or shows mild lesions.

5. Abdominal ultrasound, CT and MRI showed compression and dilation of the left renal vein.

6. Pressure measurement of the inferior vena cava and left renal vein confirmed left renal reflux obstruction, with the pressure difference between the left renal vein and the inferior vena cava being more than 4 mmHg (there are also reports of a pressure difference of 5 mmHg).

7. Rule out other possible causes of hematuria.

The "gold standard" for diagnosing this disease is left renal venography. The diagnosis can be confirmed by measuring the pressure difference between its distal end and the inferior vena cava >0.49kpa. However, angiography is an invasive examination. In comparison, ultrasound examination is convenient and easy and should be the most commonly used examination method. Doppler B-ultrasound examination can confirm the diagnosis by showing that the inner diameter of the compressed left renal vein expands more than 3 times in the supine, upright, left lateral and right lateral positions.