title: Diagnosis and successful surgical management of posterior nutcracker syndrome in a patient with loin pain hematuria.
abstract: The syndrome of loin pain hematuria in the absence of stones is poorly understood but must be considered in the differential diagnosis for patients with clinical manifestations resembling nephrolithiasis. A 22-year-old white female with a 4-year history of left flank pain and hematuria underwent an extensive workup with normal renal ultrasound and cystourethroscopies. CT scan and MRI revealed a retro-aortic left renal vein. Posterior nutcracker syndrome was considered the most likely diagnosis. The patient underwent a left laparoscopic nephrectomy with auto-transplantation in the right iliac fossa. She developed azotemia shortly after, which resolved and since then has become asymptomatic.
authors.forename: Fahd
authors.initials: F
authors.lastname: Syed
authors.forename: Quynh
authors.initials: Q
authors.lastname: Lam
authors.forename: Najindra
authors.initials: N
authors.lastname: Maharjan
authors.forename: Didier
authors.initials: D
authors.lastname: Portilla
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Smeds
authors.forename: Daniel
authors.initials: D
authors.lastname: Borja-Cacho
mesh_terms: D000792:Angiography; D064592:Autografts; D005260:Female; D021501:Flank Pain / Q000209:etiology*; D006417:Hematuria / Q000209:etiology*; D006801:Humans; D007668:Kidney / Q000098:blood supply; D016030:Kidney Transplantation; D010535:Laparoscopy; D008279:Magnetic Resonance Imaging; D009392:Nephrectomy; D059228:Renal Nutcracker Syndrome / Q000175:diagnosis* / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D055815:Young Adult