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Nephrol Dial Transplant. 2011 Feb;26(2):562-5. doi: 10.1093/ndt/gfq444. Epub 2010 Jul 23.

Renal vein obstruction and orthostatic proteinuria: a review.

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1
Emergency Unit, Clinica Pediatrica De Marchi, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy.

Abstract

OBJECTIVES:

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). However, reports dealing with proteinuria only marginally refer to this possible cause of orthostatic proteinuria. We analysed the corresponding literature.

RESULTS:

Five reports addressed the frequency of renal nutcracker in 229 subjects with orthostatic proteinuria. Their age ranged between 5.2 and 17 years (female-to-male ratio: 0.96:1.00). Imaging studies demonstrated renal nutcracker in 156 (68%) subjects. Renal nutcracker was also demonstrated in 9 anecdotal reports for a total of 53 subjects with postural proteinuria. Very recently, 13 Italian subjects with orthostatic proteinuria associated with renal nutcracker were reassessed 6 years after the initial diagnosis: in nine subjects, both orthostatic proteinuria and renal nutcracker had disappeared; in three, both orthostatic proteinuria and renal nutcracker had persisted; and in one, orthostatic proteinuria had persisted unassociated with renal nutcracker.

CONCLUSIONS:

These data provide substantial support for renal nutcracker as a common cause of orthostatic proteinuria.

PMID:
20656752
DOI:
10.1093/ndt/gfq444
[Indexed for MEDLINE]
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