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Experimental and Clinical... Apr 2017Transplant renal vein thrombosis usually occurs early after surgery with a reported prevalence of 0.1% to 4.2%. It is a devastating event that ultimately leads to graft... (Review)
Review
Transplant renal vein thrombosis usually occurs early after surgery with a reported prevalence of 0.1% to 4.2%. It is a devastating event that ultimately leads to graft loss in almost all cases. There are many predisposing factors related to donor, recipient, surgery, and immunosuppression, with mechanical factors being considered the most common causes of transplant renal vein thrombosis. The clinical manifestations of acute renal vein thrombosis are nonspecific and are not dissimilar to the features of urine leak, urinary obstruction, or severe acute rejection. The diagnosis of transplant renal vein thrombosis depends on a high index of clinical suspicion and duplex ultrasonographic scans. Although venography remains the criterion standard, this procedure is invasive and nephrotoxic, due to use of ionizing contrast agents and also due to exposure to ionizing radiation. There are 2 therapies that have been described in the literature for salvaging a renal allograft with transplant renal vein thrombosis: thrombolytic therapy and surgical thrombectomy. The usual end result is renal allograft.
Topics: Allografts; Humans; Immunosuppressive Agents; Kidney Transplantation; Magnetic Resonance Angiography; Nephrectomy; Predictive Value of Tests; Prevalence; Renal Veins; Risk Factors; Thrombectomy; Thrombolytic Therapy; Time Factors; Treatment Outcome; Ultrasonography, Doppler, Duplex; Venous Thrombosis
PubMed: 28338457
DOI: 10.6002/ect.2016.0060 -
Journal of Radiology Case Reports May 2022Nutcracker syndrome (NCS) is a rare condition caused by the compression of the left renal vein between the abdominal aorta and the superior mesenteric artery. NCS may...
Nutcracker syndrome (NCS) is a rare condition caused by the compression of the left renal vein between the abdominal aorta and the superior mesenteric artery. NCS may present with unexplained hematuria. This case report presents a 43-year-old healthy female without any complaints who had newly-detected hematuria in urinalysis during her annual examination. Her physical examination and the whole abdominal ultrasonography failed to explain the cause of hematuria. Further investigation with contrast-enhanced upper abdominal computed tomography revealed a NCS. In unexplained cases of asymptomatic hematuria NCS should be taken into account after excluding other preliminary diagnoses.
Topics: Adult; Female; Hematuria; Humans; Mesenteric Artery, Superior; Renal Veins; Syndrome; Tomography, X-Ray Computed
PubMed: 35711687
DOI: 10.3941/jrcr.v16i5.4339 -
Medicina 2019Nutcracker syndrome is a vascular anomaly consisting in the compression of the left renal vein between the superior mesenteric artery and the aorta. Clinical features in...
Nutcracker syndrome is a vascular anomaly consisting in the compression of the left renal vein between the superior mesenteric artery and the aorta. Clinical features in nutcracker syndrome include pelvic pain, flank pain, haematuria, gonadal varices or simply asymptomatic. We are presenting two cases, one of them with macroscopic haematuria and flank pain and the other was studied for hypertension but with previous antecedents of left renal vein embolization in the setting of varicocele. We discuss the clinical presentation as well as diagnostic and therapeutic aspects related to this syndrome.
Topics: Adolescent; Adult; Computed Tomography Angiography; Female; Hematuria; Humans; Renal Nutcracker Syndrome; Renal Veins
PubMed: 31048282
DOI: No ID Found -
European Journal of Vascular and... Aug 2007The aim of this article is to review the published English literature on aetiology, pathology, clinical presentation, diagnostic methods and treatment of renal vein... (Review)
Review
OBJECTIVE
The aim of this article is to review the published English literature on aetiology, pathology, clinical presentation, diagnostic methods and treatment of renal vein thrombosis.
MATERIALS AND METHODS
We searched the published literature from Medline & Pubmed using keywords renal vein thrombosis, anti-phospholipid syndrome and nephrotic syndrome. Data was extracted from individual case reports, case series, articles on pathology, diagnostic tests, treatment modalities, and previous reviews. Case reports which did not add any new information were excluded.
RESULTS
We selected 60 references based on the above criteria. Renal vein thrombosis is relatively rare. CT angiography is considered the investigation of choice. Alternatives include MR angiography or renal venography in highly selected patients. As the condition is relatively uncommon, consensus on the best form of therapy for this condition has been slow to evolve. The trend in management has shifted to non-surgical therapies particularly systemic anticoagulation except in highly selected group of patients.
Topics: Anticoagulants; Humans; Magnetic Resonance Angiography; Patient Selection; Phlebography; Practice Guidelines as Topic; Renal Veins; Tomography, X-Ray Computed; Treatment Outcome; Vascular Surgical Procedures; Venous Thrombosis
PubMed: 17543556
DOI: 10.1016/j.ejvs.2007.02.017 -
Seminars in Cell & Developmental Biology Jul 2019The kidney vasculature has a unique and complex architecture that is central for the kidney to exert its multiple and essential physiological functions with the ultimate... (Review)
Review
The kidney vasculature has a unique and complex architecture that is central for the kidney to exert its multiple and essential physiological functions with the ultimate goal of maintaining homeostasis. An appropriate development and coordinated assembly of the different vascular cell types and their association with the corresponding nephrons is crucial for the generation of a functioning kidney. In this review we provide an overview of the renal vascular anatomy, histology, and current knowledge of the embryological origin and molecular pathways involved in its development. Understanding the cellular and molecular mechanisms involved in renal vascular development is the first step to advance the field of regenerative medicine.
Topics: Animals; Gene Expression Regulation, Developmental; Humans; Kidney; Neovascularization, Physiologic; Nephrons; Regenerative Medicine; Renal Artery; Renal Veins
PubMed: 29879472
DOI: 10.1016/j.semcdb.2018.06.001 -
Nephrology, Dialysis, Transplantation :... Feb 2011The 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... (Review)
Review
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.
Topics: Adolescent; Child; Child, Preschool; Constriction, Pathologic; Female; Humans; Kidney; Kidney Diseases; Male; Posture; Proteinuria; Renal Veins; Venous Insufficiency
PubMed: 20656752
DOI: 10.1093/ndt/gfq444 -
Renal Failure Dec 2022The aims of the study were to identify whether left renal vein (LRV) entrapment was more prevalent in IgA nephropathy (IgAN) and Henoch-Schönlein purpura nephritis...
OBJECTIVES
The aims of the study were to identify whether left renal vein (LRV) entrapment was more prevalent in IgA nephropathy (IgAN) and Henoch-Schönlein purpura nephritis (HSPN) compared with other types of renal diseases, and the association of LRV entrapment with glomerular incidental IgA and galactose-deficient-IgA1 (Gd-IgA1) deposition.
METHODS
A total of 797 patients with biopsy-proven kidney diseases have been screened for LRV entrapment by color Doppler ultrasound, and the prevalence of LRV entrapment in different types of renal diseases were then analyzed. Propensity score matching analysis was used to adjust for age, gender, and body mass index. Immunostaining of Gd-IgA1 with KM55 was performed in paraffin-embedded sections of renal biopsy specimens.
RESULTS
LRV entrapment was diagnosed in 47 patients (6%) with several kinds of renal diseases in our cohort. A total of 32 (68%) LRV entrapments were combined with expanded IgAN (idiopathic IgAN and HSPN). The prevalence of LRV entrapment in expanded IgAN was significantly higher than that in non-expanded IgAN (17 vs. 2%, < 0.001), even after adjustment for age, gender, and body mass index by propensity score matching analysis (13 vs. 2%, < 0.001). Removing expanded IgAN and LN, glomerular incidental IgA deposition was observed to be significantly more common in patients with LRV entrapment compared with patients without it (43 vs. 9%, < 0.001). Furthermore, in glomerular diseases with incidental IgA deposits, significantly much larger proportion of patients with LRV entrapment were positive for glomerular Gd-IgA1 in contrast to patients without LRV entrapment (5/5 5/17, = 0.01).
CONCLUSIONS
LRV entrapment coexisted with several kinds of renal diseases, with a significantly higher prevalence in patients with idiopathic IgAN and HSPN. In patients of LN and IgAN-unrelated disease with LRV entrapment, glomerular IgA and Gd-IgA1 deposition was more common compared with patients without LRV entrapment.
Topics: Glomerulonephritis; Glomerulonephritis, IGA; Humans; IgA Vasculitis; Immunoglobulin A; Nephritis; Renal Veins
PubMed: 36069515
DOI: 10.1080/0886022X.2022.2118065 -
BMJ Case Reports Jul 2018An older male patient with a history of tachycardia treated with atenolol presented to an outside hospital on 22 February 2017 with acute right flank pain. He had a CT...
An older male patient with a history of tachycardia treated with atenolol presented to an outside hospital on 22 February 2017 with acute right flank pain. He had a CT scan which revealed a large right renal mass with acute haemorrhage. He was initially managed with interventional radiology guided embolism on 25 February 2017 due to the ongoing bleeding and haemodynamic instability. He was then transferred to our institution. He underwent right radical nephrectomy on 13 March 2017. His pathology revealed a 12.5×6×4.5 cm mass consistent with angiosarcoma of the right kidney with negative margins. Final pathology was pT2b with extension of the mass into the renal vein and perirenal adipose tissue. He was discharged soon after surgery. He was recommended to undergo adjuvant chemotherapy.
Topics: Aged; Chemotherapy, Adjuvant; Fatal Outcome; Flank Pain; Hemangiosarcoma; Humans; Image-Guided Biopsy; Kidney Neoplasms; Male; Nephrectomy; Renal Veins
PubMed: 30061122
DOI: 10.1136/bcr-2017-222672 -
Advances in Kidney Disease and Health Mar 2023Acid-base homeostasis is critical to the maintenance of normal health. The kidneys have a central role in bicarbonate generation, which occurs through the process of net... (Review)
Review
Acid-base homeostasis is critical to the maintenance of normal health. The kidneys have a central role in bicarbonate generation, which occurs through the process of net acid excretion. Renal ammonia excretion is the predominant component of renal net acid excretion under basal conditions and in response to acid-base disturbances. Ammonia produced in the kidney is selectively transported into the urine or the renal vein. The amount of ammonia produced by the kidney that is excreted in the urine varies dramatically in response to physiological stimuli. Recent studies have advanced our understanding of ammonia metabolism's molecular mechanisms and regulation. Ammonia transport has been advanced by recognizing that the specific transport of NH3 and NH by specific membrane proteins is critical to ammonia transport. Other studies show that proximal tubule protein, NBCe1, specifically the A variant, significantly regulates renal ammonia metabolism. This review discusses these critical aspects of the emerging features of ammonia metabolism and transport.
Topics: Ammonia; Kidney; Nephrons; Renal Veins; Ammonium Compounds
PubMed: 36868733
DOI: 10.1053/j.akdh.2022.12.005 -
Korean Journal of Radiology Dec 2019Nutcracker syndrome (NCS) is a syndrome caused by compression of the left renal vein (LRV), between the abdominal aorta and the superior mesenteric artery, resulting in... (Review)
Review
Nutcracker syndrome (NCS) is a syndrome caused by compression of the left renal vein (LRV), between the abdominal aorta and the superior mesenteric artery, resulting in hypertension of the LRV and hematuria. Doppler ultrasonography (US) has been commonly used for the diagnosis of NCS. However, several technical issues, such as Doppler angle and sample volume, need to be considered to obtain satisfactory results. In addition, morphologic changes of the LRV and a jetting phenomenon across the aortomesenteric portion of the LRV on contrast-enhanced computed tomography (CECT) are diagnostic clues of NCS. With proper Doppler US and CECT, NCS can be diagnosed noninvasively.
Topics: Contrast Media; Diagnosis, Differential; Humans; Renal Nutcracker Syndrome; Renal Veins; Tomography, X-Ray Computed; Ultrasonography, Doppler
PubMed: 31854150
DOI: 10.3348/kjr.2019.0084