Periodic Renal Pain: Nutcracker Syndrome Due to Duplication of the Left Renal Vein

Abstract

The Nutcracker syndrome is a rare condition, resulting from increased pressure in the left renal vein due to different anatomical anomalies. It presents with non-specific symptoms, such as low back pain, hematuria or varicocele, that lead to late diagnosis. We present the case of a 22-year-old patient with multiple episodes of high-intensity and recurrent low back pain, usually preceding the beginning of the catamenium. The imaging study of the vascular territory revealed anomalies in the left pelvic venous vasculature, with duplication of the homolateral renal vein, conditioning pelvic congestion. After several admissions (3 hospitalizations with diagnosis of acute pyelonephritis), the patient underwent angioplasty of the left renal vein with embolization of the gonadal vein. After a period of symptomatic resolution, there was symptomatic relapse associated with renal dysfunction, which conditioned the renal autotransplantation with insertion in the left iliac fossa. A high level of suspicion is essential, especially in the absence of response to conservative treatment and in the recurrence of symptoms without imaging findings suggesting other pathologies of an obstructive and / or inflammatory nature.