title: Micro- and macroscopic hematuria caused by renal vein entrapment: systematic review of the literature.
abstract: BACKGROUND
  Hematuria secondary to renal vein entrapment is mentioned only passing in textbooks and reviews.
  
  
  METHODS
  We performed a search of the National Library of Medicine database for peer-reviewed publications using the terms "renal vein" or "nutcracker" and "hematuria".
  
  
  RESULTS
  We identified 187 published reports/studies that covered 736 patients, of whom 288 had microscopic hematuria and 448 had macroscopic hematuria. The patient cohort comprised 159 patients aged ≤17 years. Abdominal pain was absent in  approximately 65% of all patients, and a clinically relevant left-sided varicocele was observed in 29% of the male patients. A normal pre-aortic left renal vein and an anomalous anatomy were noted in 680 and 56 patients, respectively. The body mass index (BMI) was lower in patients with renal vein entrapment than in the controls, with a regression of hematuria correlating with an increase in BMI. A surgical procedure was attempted in 34% of the patients, of which the most common were endovascular stenting and transposition of the renal vein distally into the vena cava.
  
  
  CONCLUSIONS
  In cases of unexplained hematuria with or without abdominal pain, clinicians should consider the diagnosis of renal vein congestion, especially in males with varicocele. Ultrasonic Doppler flow scanning is the recommended initial diagnostic modality in these patients. Expectation management is advised in the great majority of cases.
authors: Pediatric Emergency Department, Ospedale Maggiore Policlinico, Foundation IRCCS Ca' Granda, Milan, Italy.
authors: Federica A
authors: FA
authors: Vianello
authors: Pediatric Emergency Department, Ospedale Maggiore Policlinico, Foundation IRCCS Ca' Granda, Milan, Italy.
authors: Marta B M
authors: MB
authors: Mazzoni
authors: Pediatric Emergency Department, Ospedale Maggiore Policlinico, Foundation IRCCS Ca' Granda, Milan, Italy.|Pediatric Department of Southern Switzerland, Bellinzona, Switzerland.
authors: Gabriëlla G A M
authors: GG
authors: Peeters
authors: Pediatric Emergency Department, Ospedale Maggiore Policlinico, Foundation IRCCS Ca' Granda, Milan, Italy.
authors: Emilio F
authors: EF
authors: Fossali
authors: Pediatric Emergency Department, Ospedale Maggiore Policlinico, Foundation IRCCS Ca' Granda, Milan, Italy.|Pediatric Department of Southern Switzerland, Bellinzona, Switzerland.
authors: Pietro
authors: P
authors: Camozzi
authors: Pediatric Department of Southern Switzerland, Bellinzona, Switzerland. mario.bianchetti@pediatrician.ch.
authors: Mario G
authors: MG
authors: Bianchetti
authors: Pediatric Emergency Department, Ospedale Maggiore Policlinico, Foundation IRCCS Ca' Granda, Milan, Italy.
authors: Gregorio P
authors: GP
authors: Milani
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003251:Constriction, Pathologic; D005260:Female; D006417:Hematuria / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D059228:Renal Nutcracker Syndrome / Q000150:complications*; D012082:Renal Veins / Q000473:pathology* / Q000601:surgery; D055815:Young Adult
keywords: Abdominal pain; Hematuria; Nutcracker; Renal vein congestion; Renal vein entrapment
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