Nutcracker Syndrome with Pelvic Congestion: A Case Report

A 21-year-old woman was found to have had hematuria and proteinuria for 5 years. After she was referred to our hospital, her laboratory findings showed urinary red blood cells (RBCs)>100/high-powered field without any dysmorphic RBCs and proteinuria (0.66 g/g-creatinine) without renal dysfunction. Furthermore, increased brightness at her renal cortex was confirmed on abdominal ultrasonography. Chronic proliferative glomerulonephritis (CGN) was highly suspected; therefore, a renal biopsy was performed. Her pathological findings showed no abnormality, and contrastenhanced abdominal computed tomography revealed left renal vein compression (Picture A) with ovarian vein varices (Picture B). Therefore, we diagnosed the patient to have nutcracker syndrome with pelvic congestion. This disease is rare (1). Although a renal biopsy might have been unnecessary in this case, her clinical manifestations mimicked those of CGN; furthermore, immunoglobulin A nephropathy with nutcracker syndrome has been reported (2). Therefore, although CGN was suspected, careful attention should be given to the possibility of nutcracker syndrome with pelvic congestion when encountering such cases.