Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
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Effect of renal Doppler ultrasound on the detection of nutcracker syndrome in children presenting orthostatic proteinuria

  • Eun Jae Hwang (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Ji Hong Kim (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Mi-Jung Lee (Department of Radiology, Severance Hospital and Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Haesung Yoon (Department of Radiology, Severance Hospital and Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Jae Il Shin (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Keum Hwa Lee (Department of Pediatrics, Yonsei University College of Medicine)
  • Received : 2024.05.17
  • Accepted : 2024.06.11
  • Published : 2024.06.30
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Abstract

Purpose: To compare the Doppler sonographic findings of the left renal vein (LRV) of children diagnosed with nutcracker syndrome with and without orthostatic proteinuria. Methods: Fifty and 53 consecutive children with and without orthostatic proteinuria, respectively, underwent renal Doppler ultrasonography examinations. The peak velocity (PV) was measured at the hilar portion of the LRV and between the aorta and superior mesenteric artery. Renal Doppler ultrasonography findings and clinical data including urine protein-to-creatinine ratio (UPCR) were compared according to the presence or absence of orthostatic proteinuria. Results: Between the two groups, no significant differences were observed in terms of age or sex. The PV ratio between the aortomesenteric and hilar portions was 7.79±2.65 and 6.32±3.01 in children with and without orthostatic proteinuria, respectively (P=0.009). No significant differences were observed between the two groups in terms of the UPCR in the first morning urine sample. However, the UPCR in the afternoon urine sample was significantly higher in children with orthostatic proteinuria than in those without orthostatic proteinuria (0.49±0.46 mg/mg vs. 0.11±0.04 mg/mg, P<0.001). Furthermore, the PV ratio between the aortomesenteric and hilar portions revealed a positive correlation with the ratio of UPCR of the afternoon to that of first morning urine samples (R=0.21, P=0.034). Conclusions: This study suggests that there can be a significant correlation of the PV ratio between the aortomesenteric and hilar portion of the LRV with orthostatic proteinuria in pediatric patients with nutcracker syndrome.

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References

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