Renal vein obstruction and orthostatic proteinuria: a review.
OBJECTIVE
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.
Mazzoni
Marta B M
MB
Emergency Unit, Clinica Pediatrica De Marchi, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy.
Kottanatu
Lisa
L
Simonetti
Giacomo D
GD
Ragazzi
Monica
M
Bianchetti
Mario G
MG
Fossali
Emilio F
EF
Milani
Gregorio P
GP
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007668:Kidney / Q000098:blood supply*; D007674:Kidney Diseases / Q000150:complications*; D008297:Male; D011187:Posture; D011507:Proteinuria / Q000209:etiology*; D012082:Renal Veins / Q000503:physiopathology*; D014689:Venous Insufficiency / Q000150:complications*