Kidneys are two bean-shaped organs in the body that control vital functions in the body, such as: removing wastes from the blood, balancing bodily fluids, and making urine. Each kidney usually has a vein that carries blood filtered by the kidney to different places in the body. These are called renal veins, one on the right and one on the left. In Nutcracker Syndrome, the vein coming from the left kidney shrinks and blood is not able to flow normally into it. Instead, blood flows backward into other veins and they become swollen. This can also increase pressure on the kidneys and cause blood in the urine or pain. There are two main types of Nutcracker syndrome: anterior and posterior. It also has many subtypes.

  • In anterior nutcracker syndrome, the left renal vein narrows between the aorta and another abdominal artery. This is the most common type of Nutcracker syndrome.
  • ​In posterior nutcracker syndrome, the left renal vein is usually compressed between the aorta and the spine.

It is called nutcracker syndrome because compression of the renal vein resembles a nutcracker cracking a nut. Symptoms include blood in the urine and abdominal pain. Surgery and invasive procedures can relieve pressure on the renal vein.

(Read more: Kidney Diseases)

  1. Who Does Nutcracker Syndrome Affect
  2. Side Effect of Nutcracker Syndrome
  3. Symptoms of Nutcracker syndrome
  4. Causes of Nutcracker syndrome
  5. Diagnosis of Nutcracker syndrome
  6. Treatment of Nutcracker syndrome
  7. Prevention of Nutcracker syndrome
  8. Summary
Doctors for Understanding Nutcracker Syndrome: Causes, Symptoms, and Treatments

Nutcracker syndrome affects children and adults up to the age of 60. It occurs most commonly in people in their teens, 20s, and 30s. It is also common in people who have a low body mass index (BMI). 

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Nutcracker syndrome may cause mild or sometimes no symptoms and may resolve on its own (especially in children). However, sometimes it can cause harm to the body if left untreated over time. Potential complications of unmanaged Nutcracker syndrome include:

  • Blood Clot In Kidney Vein
  • Increasing Pressure In Your Kidney Veins Over Time
  • Severe Pain
  • Blood Clot In LRV
  • Anemia Caused By Blood In Urine
  • Enlargement Of Veins Within The Scrotum In Men
  • Pelvic Congestion Syndrome (Pcs) In Women
  • Infection

(Read more: End-Stage Renal Disease)

Usually no symptoms are seen. Once symptoms appear it is called Nutcracker Syndrome. Common signs and symptoms include:

(Read more: Kidney Infection)

The causes of Nutcracker syndrome can vary. Some people are born with blood vessel variations that can lead to symptoms of Nutcracker syndrome. The syndrome may also be caused by changes inside the abdomen. Symptoms are more common in women in their 20s and 30s, but it can affect people of any age. Some conditions that may increase the chance of developing Nutcracker syndrome include:

  • Pancreas Tumors
  • Tumors In Stomach Tissue
  • Subluxation Of Spine
  • Nephroptosis, Dropping Of The Kidney Into The Pelvis Upon Standing.
  • Rapid Change In Height Or Weight
  • Low Body Mass Index
  • Enlarged Lymph Nodes In The Abdomen
  • Pregnancy

In children, rapid growth during puberty can lead to Nutcracker syndrome. As body proportions change, the renal veins become compressed.

(Read more: Know How to Prevent Kidney Stones )

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First the doctor does a physical examination and asks about the medical history and then asks about the symptoms to decide on treatment. If doctors suspect Nutcracker syndrome, urine samples are taken to check for blood, protein, and bacteria. Blood samples may be used to check blood cell counts and kidney function. This will help in treatment. This is followed by a Doppler ultrasound of the kidney area to see if there is abnormal blood flow in the veins and arteries. Depending on the anatomy and symptoms, a CT scan or MRI may also be performed to look more closely at the kidneys, blood vessels, and other organs to find out where and why the vein is narrowed. Kidney biopsy is also done to help rule out other conditions. Treating Nutcracker syndrome may take some time because the doctor needs to rule out many other possible problems. Tests that may be needed to determine treatment include:

(Read more: Fruits to eat and avoid in kidney stone)

Some first steps to diagnose Nutcracker Syndrome include a urine test. If symptoms are more severe or do not improve after an observation period of 18 to 24 months, treatment may be needed. A variety of treatment options exist such as –

A stent is a small mesh tube that keeps the narrowed vein open and allows blood to flow normally. This procedure has been used to treat this condition for about 20 years. The doctor inserts the stent by making a small incision in your leg and using a catheter to move the stent into the appropriate position inside the vein. Stent placement requires an overnight stay in the hospital and complete recovery may take several months. You should discuss the risks and benefits of this procedure, as well as other treatment options, with your doctor.

Blood Vessel Surgery
If symptoms are more severe, blood vessel surgery is a better option. Doctors recommend a variety of surgical procedures to relieve pressure on the vein. Options may include moving the nerve and reattaching it. Another option is bypass surgery, in which a vein taken from elsewhere in your body can be replaced with a shrunken vein. Recovery from surgery depends on the type of surgery and overall health. Generally this takes several months.

Renal Autotransplantation Surgery
In this, the kidney is removed from its original place and re-transplanted to a new place near the hip bone.

(Read more: Diet for good kidney health)

If you are struggling with this type of problem, it is important to keep track of your medical appointments and screenings. This can help the doctor identify renal vein compression to get the right treatment by being more aware of the possible signs and symptoms. If you have been experiencing symptoms for some time but don't know the cause, go and talk to your doctor.

Nutcracker syndrome can be difficult for doctors to diagnose, but once it is diagnosed, it can be cured. Treating the condition depends on the cause. In many cases in children, Nutcracker syndrome with mild symptoms resolves on its own within two years. If there are more severe symptoms, there are several options available to heal the affected nerve and provide short-term and long-term relief. In people with Nutcracker syndrome caused by certain medical conditions or tumors, blood flow problems may improve.

Dr. Anvesh Parmar

Dr. Anvesh Parmar

12 Years of Experience



36 Years of Experience

Dr. Mohammed A Rafey

Dr. Mohammed A Rafey

25 Years of Experience

Dr. Soundararajan Periyasamy

Dr. Soundararajan Periyasamy

30 Years of Experience

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