The 38-year-old patient was presented because of gross hematuria. No dysmorphic erythrocytes could be detected in phase contrast microscopy. Cystoscopy confirmed isolated hematuria from the left ureter only. There were no indications of any other cause of the hematuria. A nutcracker phenomenon was shown on portal venous CT angiography of the kidneys. This is characterized by an anatomical standard variant with the course of the left renal vein between the abdominal aorta and the superior mesenteric artery. In this case, secondary venous outflow disturbances in the area of the ovarian vein or testes can result from an impingement of the left renal vein. Typical symptoms include hematuria and orthostatic proteinuria, pain in the left flank or dyspareunia in women. Often, however, the patients are also symptom-free. Therapeutically, angiography with stent placement in the left renal vein or autotransplantation in the pelvis can be considered.
Dr. med. Frank-Peter Tillmann, Clinic for Nephrology, Heinrich Heine University Düsseldorf, frank-peter.tillmann@gmx.de
Conflict of interest: The author declares that there is no conflict of interest.
Citation: Tillmann FP: A rare cause of macrohematuria. Dtsch Arztebl Int 2018; 115: 878. DOI: 10.3238 / arztebl.2018.0878a
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