Clinical features of children with nutcracker syndrome in different age groups / 中华实用儿科临床杂志

ABSTRACT

Objective To provide a reference for early detection and diagnosis of nutcracker syndrome(NCS) by analyzing the clinical features of children with NCS in different age groups and different gender groups.Methods Data of 112 children with simple NCS diagnosed at the Department of Nephrology of Chongqing Children's Hospital from January 2008 to January 2018 were analyzed retrospectively.Follow-up was conducted.Results In children with NCS,71 girls accounted for 63.4％,mainly in preschool age(82.4％,28 cases);41 boys accounted for 36.6％,mainly in school age(48.5％,8 cases) and adolescence(42.2％,7 cases).Fifty-one point two percent (21/41 cases) of boys presented with both hematuria and proteinuria after activities,60.6％ (43/59 cases) of girls presented with isolated hematuria after activities,while 46.7％ (21/45 cases) children in adolescence were most likely to appear lumbar and abdominal pain after activities,and the incidence of boys(63.2％,12 cases) was higher than girls (34.6％,9 cases),and the differences above were all statistically significant (x2 =6.939,P ＜ 0.05).The 24-hour urinary protein level in adolescent group was significantly higher than that in 2 groups of younger children,and the male children[0.09 (0.02-0.21) g/d] in this group were significantly higher than that in female children[0.06 (0.01-0.21) g/d] (x2 =6.48,P ＜ 0.05).The detection rate of CT angiography (CTA) (95.7 ％,67/70 cases) was significantly higher than that of color Doppler ultrasound (82.4％,75/91 cases),and the difference was statistically significant (x2 =6.721,P ＜ 0.05).Children with NCS in adolescence had smaller aortomesenteric angles (AMA) and larger ratios of the internal diameter of left renal vein(LRV) 's dilation part (a) to the stenosis part(b) (a/b) than those in preschool age and school age,and the difference was statistically significant (F =4.797,P ＜ 0.05).By follow-up of 96 cases for 3 months-7 years,there were 51 cases(58.0％) whose urine was back to normal in 88 cases who had reexamination of urine,and among the 54 patients who underwent color doppler ultrasound,25 cases(46.3％) showed relief of LRV compression.Conclusions There are more girls with NCS than boys,and girls are mainly in preschool age and always present with isolated hematuria,while boys are mainly in school age and adolescence and always presented with both hematuria and proteinuria.Children in adolescence were most likely to appear lumbar and abdominal pain,and boys have a higher incidence rate than girls.Children in school age and adolescence have the relatively higher quantitation level of proteinuria,and the smaller AMA and the larger a/b ratio,the more serious compression of LRV,and it's especially obvious in adolescence.