A Real Nutcracker of a Problem…

Nutcracker syndrome is a rare but painful condition where a vein gets compressed, causing discomfort and circulation issues. Though tricky to diagnose, treatment options exist to help manage symptoms.

WORDS ABRAHAM MATHEW SAJI

Let’s talk about the nutcracker phenomenon. Believe me, it has nothing to do with the famous ballet, the nutcracker device, or the cracking of nuts.

SO, WHAT IS IT?

It is a painful, or sometimes silent, disorder of the urinary system.

To better understand this disorder, first let’s get a peek into a part of our urinary system.

• We are blessed with two kidney-shaped organs called kidneys.
• They carry out important functions such as regulating fluid volume, balancing the electrolyte content of our body, and removing waste via urine.
• The blood filtered by each kidney is transported to the main bloodstream via renal veins. See the image above.

Sometimes, the left renal vein becomes compressed.

• This leads to impaired or backward blood flow in that vein. The person with this condition may experience pain and find blood in the urine as a result.
• The person is said to have the nutcracker phenomenon—this name came from how the compression of the vein is comparable to how a nutcracker cracks open a nut.
• Another perhaps more dignified name for this condition is renal vein entrapment syndrome.

Not everyone with this issue develops symptoms.

• People with symptoms are said to have nutcracker syndrome.
• This typically occurs when the left renal vein is compressed by other blood vessels near the kidney.

A STILL POORLY UNDERSTOOD CONDITION

• The nutcracker phenomenon is still not a fully understood condition.
• What we do know is that it is not passed on from parent to child.
• Also, the nutcracker syndrome is commonly seen in women that also have pelvic vein diseases such as pelvic congestion and May-Thurner syndrome—suggesting that diseases that affect the structure and arrangement of blood vessels near the kidneys could lead to the development of this syndrome.
• Furthermore, it is observed that the symptoms of the nutcracker syndrome tend to be more severe among children, while adults that develop nutcracker syndrome tend to show milder symptoms in comparison.

WHO IS MOST SUSCEPTIBLE?

Anyone can develop the nutcracker phenomenon, regardless of age or sex.

WHAT ARE THE SYMPTOMS?

• Abdominal and/or pelvic pain that could extend to the buttocks and thigh—the pain may become worse when one attempts to sit, stand, walk, or ride in a vehicle that is shaky or moving on bumpy terrain
• Blood in the urine (haematuria)
• Enlarged testicular veins (varicocele)
• Pain in the pelvis area during sexual intercourse or urination
• Polycystic ovaries with severely painful menstrual cramps
• Light-headedness when attempting to stand upright; this sensation goes away when one sits down

IF YOU THINK YOU HAVE THIS CONDITION

• You should seek medical attention.
• The condition can be diagnosed through a series of blood and kidney function tests, followed by ultrasound, CT, or MRI scans around the kidney area.
• A sampling of tissue from the affected kidney may also be carried out for further investigation.

TREATMENT

• The good news is that milder symptoms may go away on their own without any need for medical intervention.
• Nonetheless, the doctor may still want to perform follow-up examinations and observations just to be on the safe side.
• For more severe symptoms, treatment options may include surgical introduction of a stent into the affected renal vein to improve blood flow. The exact treatment option, however, will depend on the severity of the symptoms.

References:

1. Genetic and Rare Diseases Information Center. (n.d.). Renal nutcracker syndrome. https://rarediseases.info.nih.gov/diseases/11971/renal-nutcracker-syndrome
2. University of Pittsburgh Medical Centre Heart and Vascular Institute. (n.d.). Nutcracker syndrome. https://www.upmc.com/services/heart-vascular/conditions-treatments/nutcracker-syndrome