The nutcracker syndrome: new methods of diagnosis and treatment

Objective To study the pathophysiology of the nutcracker syndrome and to describe a new method of treatment. Subjects and methods Computerized tomography (CT) was used to compare the anatomical relations of the left renal vein with the aorta and the superior mesenteric artery in three patients with the nutcracker syndrome and in a control group of 12 healthy kidney donors. Results Abnormal branching of the superior mesenteric artery from the arota was identified as the cause of the nutcraker syndrome. Two patients were treated by autotransplantation of the left kidney, while the third refused surgery. In the treated patients haematuria ceased 4 and 6 weeks after surgery. Postoperative excretory urography and repeated isotopic studies revealed perfect configuration and function of the autotransplanted kidneys. The patients remain asymptomatic 6 and 12 months after surgery. Conclusion In patients with haematuria from the left kidney, angiographic CT must be considered before phlebography and pressure measurement of the left renal vein. If the diagnosis of the nutcracker syndrome is established, autotransplantation of the left kidney is a treatment alternative. © 1994 British Journal of Urology