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. 2014 Nov;44(6):434-6.
doi: 10.4070/kcj.2014.44.6.434. Epub 2014 Nov 25.

A case of secondary hypertension associated with the nutcracker phenomenon

Se-Jun Park  1 , Sun-Mi Kim  1 , Je-Hwan Won  2 , Hong-Seok Lim  1
Affiliations

A case of secondary hypertension associated with the nutcracker phenomenon

Se-Jun Park et al. Korean Circ J. 2014 Nov.

Abstract

A 25-year-old Korean woman was referred for uncontrolled hypertension. Laboratory examination revealed increased plasma renin activity and microscopic hematuria. Computed tomography demonstrated compression of the left renal vein (LRV) between the aorta and superior mesenteric artery; however, both renal arteries were intact and there was no adrenal mass. Renal vein catheterization showed external compression with a pressure gradient of up to 8 mm Hg between the LRV and the inferior vena cava. Plasma renin activity in the LRV was almost five times higher than that in the right renal vein. In this patient, renin-dependent hypertension was caused by renal congestion due to LRV obstruction.

Keywords: Hypertension; Renal nutcracker phenomenon.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1
Fig. 1
An computed tomography image. Contrast-enhanced computed tomography demonstrating compression of the left renal vein between the aorta (Ao) and superior mesenteric artery (SMA) with dilatation of the distal part of the left renal vein (LRV).
Fig. 2
Fig. 2
Venography of the left renal vein. A: left renal vein (LRV) showing poststenotic dilatation. B: perirenal and periureteral collateral veins. C: anomalous reflux of ovarian vein and varices of ovarian plexus (arrow). The pressure gradient between the left renal vein and the inferior vena cava was 8 mm Hg (normal <3 mm Hg) and plasma renin activity in the LRV was almost five times higher than that in the right renal vein (5.88 ng/mL/hr vs. 1.17 ng/mL/hr).
See this image and copyright information in PMC

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