SynopsisCodesDifferential Diagnosis & PitfallsBest TestsReferences
Renal nutcracker syndrome
Other Resources UpToDate PubMed

Renal nutcracker syndrome

Contributors: Christine Osborne MD, Catherine Moore MD
Other Resources UpToDate PubMed


A condition in which there is compression of the left renal vein between the aorta and superior mesenteric artery, leading to elevated left renal vein pressure and possible development of collateral veins.

Patients typically present with intermittent hematuria without associated abdominal pain or flank pain. Other common presenting symptoms include proteinuria, gonadal vein syndrome, and varicocele due to development of collateral vessels.

For many patients, nutcracker syndrome is incidentally discovered on imaging done for another cause.


N28.9 – Disorder of kidney and ureter, unspecified

90708001 – Kidney disease

Differential Diagnosis & Pitfalls

Painless hematuria:
  • Renal calculus – usually painful
  • Renal cell carcinoma
  • Loin pain-hematuria syndrome
  • IgA nephropathy
  • C3 nephropathy
  • Thin basement membrane disease
  • Arteriovenous malformation in urologic tract – rare

Best Tests

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Last Updated:08/31/2023
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Renal nutcracker syndrome
A medical illustration showing key findings of Renal nutcracker syndrome : Flank pain, Lower abdominal pain, Microscopic hematuria, Proteinuria, Gross hematuria, LLQ pain
Copyright © 2024 VisualDx®. All rights reserved.