Renal vein obstruction and orthostatic proteinuria: a review

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
Marta B M MazzoniGregorio Milani

Abstract

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. 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. These data provide substantial support for renal nutcracker as a common cause of orthostatic proteinuria.

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Citations

Jun 4, 2011·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Jae Il ShinJi Hong Kim
Apr 29, 2014·International Urology and Nephrology·Arjan van der TolRaymond Vanholder
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Oct 23, 2020·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Anna ZisiEkaterini Siomou
Jan 12, 2021·KI Reports·Xiaorui YinMartin R Prince

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