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Nutcracker phenomenon
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==Dysautonomia== Takahashi et al. (2005) tested 93 pediatric patients for nutcracker phenomenon (56 with idiopathic renal bleeding, 14 with massive orthostatic proteinuria and 23 with severe orthostatic intolerance). Left renal vein occlusion (nutcracker phenomenon) was observed in 70% of the patients with severe orthostatic intolerance, and in contrast in 18% and 14% for idiopathic renal bleeding and massive orthostatic proteinuria, respectively.<ref name="Takahashi2005">{{Cite journal | last = Takahashi | first = Y. | last2 = Sano | first2 = A. | last3 = Matsuo | first3 = M. | date = Jul 2005 | title = An ultrasonographic classification for diverse clinical symptoms of pediatric nutcracker phenomenon | url =https://www.ncbi.nlm.nih.gov/pubmed/16047645|journal=Clinical Nephrology|volume=64|issue=1 | pages = 47ā54|doi=10.5414/cnp64047|issn=0301-0430|pmid=16047645}}</ref> Takemura et al. (2000) published a paper describing four adolescents diagnosed with nutcracker syndrome. Three of these patients had previously been diagnosed with orthostatic disturbance and suffered from various symptoms including fainting, tachycardia, headache and abdominal pain.<ref name="Takemura2000">{{Cite journal | last = Takemura | first = T. | last2 = Iwasa | first2 = H. | last3 = Yamamoto | first3 = S. | last4 = Hino | first4 = S. | last5 = Fukushima | first5 = K. | last6 = Isokawa | first6 = S. | last7 = Okada | first7 = M. | last8 = Yoshioka | first8 = K. | date = Sep 2000 | title = Clinical and radiological features in four adolescents with nutcracker syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/10975316|journal=Pediatric Nephrology (Berlin, Germany)|volume=14|issue=10-11|pages=1002ā1005|doi=10.1007/s004670050062|issn=0931-041X|pmid=10975316}}</ref> A case-report from Daily et al. (2012) describes a 19-year-old woman diagnosed with nutcracker syndrome. She suffered from syncope, sometimes multiple episodes in one day. Her other symptoms included unilateral hematuria, nausea, lower abdominal pain and weight loss. After she was treated with stenting of her left renal vein, her symptoms improved drastically and she had no episodes of syncope and her blood pressure normalized.<ref name=":12">{{Cite journal | last = Daily | first = Ryan | last2 = Matteo | first2 = Jerry | last3 = Loper | first3 = Todd | last4 = Northup | first4 = Martin | date = Dec 2012 | title = Nutcracker syndrome: symptoms of syncope and hypotension improved following endovascular stenting | url =https://www.ncbi.nlm.nih.gov/pubmed/22734085|journal=Vascular|volume=20|issue=6|pages=337ā341|doi=10.1258/vasc.2011.cr0320|issn=1708-5381|pmid=22734085|pmc=|quote=|access-date=|via=}}</ref> Koshimichi et al. (2012) <ref name="Koshimichi2012" /> reported that of 53 pediatric patientsĀ diagnosed with left renal vein entrapment syndrom (another term for nutcracker phenomenon), 22 patients (42%) suffered from orthostatic disturbance. Of these 22 patients: * 68% had generalĀ malaiseĀ andĀ fatigue * 64% had palpitationĀ orĀ shortnessĀ ofĀ breath * 45% had severeĀ abdominalĀ pain * 9% had increasedĀ pulseĀ (21Ā beatsĀ perĀ minuteĀ orĀ more)Ā onĀ standing There was an absence of micro/macro-hematuria in half of the patients. Proteinuria was absent in 59% of the patients. 18% of the patients had neither micro/macro-hematuria or proteinuria. Treatment with midodrine significantly decreased orthostasis scores. The most severe patients (6 of 22) had either low urinary [[cortisol]] or plasma cortisol, persistent in some and intermittent in some. These patients improved after being given a low oral dose ofĀ [[fludrocortisone]]Ā acetate to maintain sufficient blood cortisol.
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