Resources for Individuals with Nutcracker Syndrome

Nutcracker Syndrome is a rare vascular condition that occurs when the left renal vein is compressed between the abdominal aorta and the superior mesenteric artery.

If you have been diagnosed with Nutcracker Syndrome and your doctors have recommended removing the affected kidney as the best treatment option, you may be able to donate your kidney to someone in need of a kidney transplant.

Living Kidney Donation Information & Resources:

• Learn more about living kidney donation, including the process, eligibility, and next steps.
• Register as a living donor to start the donation process and see if you qualify.
• Learn about support and protections for living kidney donors, including Donor Shield, which offers reimbursement for lost wages, travel and lodging, and dependent care for living kidney donors.
• Discover how donating through the NKR’s Voucher Program can help a specific recipient or safeguard your family’s future.
• Read donor stories, get more information about living kidney donation, and learn more about Nutcracker Syndrome in the NKR blog.

LJ Dong: My Nutcracker Syndrome Kidney Donation Story

When LJ Dong was diagnosed with Nutcracker Syndrome and the first surgery to repair it did not work, her two option were redoing the surgery or having a nephrectomy to remove the kidney. The kidney itself was healthy, but the vein leading to it was not. So, she thought, If I have to take the kidney out, how can I give it to someone? Read LJ’s donation story.

Nutcracker Syndrome FAQ

What is Nutcracker Syndrome?

Nutcracker Syndrome is a condition that occurs when the left renal vein is compressed between the aorta and the superior mesenteric artery, leading to symptoms like flank pain, hematuria (blood in urine), and pelvic congestion.

Why is it called Nutcracker Syndrome?

The name comes from how the left renal vein is squeezed, like a nut in a nutcracker. This compression usually happens between the abdominal aorta (a large artery) and the superior mesenteric artery.

What causes Nutcracker Syndrome?

Nutcracker Syndrome can be caused by:

• The natural anatomy of some people, where the angle between the arteries is too small
• Weight loss, which can reduce fat cushioning around the blood vessels
• Other conditions that put pressure on the blood vessels

What are the symptoms of Nutcracker Syndrome?

Common symptoms of Nutcracker Syndrome include:

• Flank or abdominal pain
• Blood in the urine (hematuria)
• Pelvic pain or varicose veins in the lower abdomen
• Fatigue and orthostatic intolerance
• Protein in the urine (proteinuria)

How is Nutcracker Syndrome diagnosed?

Diagnosis typically involves imaging studies such as ultrasound, CT angiography, MRI, or venography to confirm vein compression, as well as urinalysis to look forsigns of hematuria or proteinuria.

What are the treatment options for Nutcracker Syndrome?

Treatment varies based on severity and may include:

• Conservative management (monitoring, lifestyle adjustments)

• Medication for symptom relief
• LRV transposition: A surgical procedure that relocates the left renal vein to a lower position on the inferior vena cava (a large vein that carries blood to the heart)
• LRV stenting: In severe cases, doctors may place a stent in the vein, which expands the vein to allow for proper blood flow to the heart.
• Transplantation: In severe cases, patients may be given two transplant options to treat their symptoms:
  • Auto-transplantation, where the nutcracker kidney is surgically removed from the patient and then transplanted back into the patient in the pelvis, near the bladder.
  • Therapeutic nephrectomy, where the patient elects to undergo a nephrectomy and chooses to donate the kidney to a patient with end-stage renal disease.

Can Nutcracker Syndrome affect kidney function?

In some cases, prolonged venous compression can lead to kidney congestion, protein loss, or even kidney dysfunction, but most patients do not experience significant kidney failure.

Can someone with Nutcracker Syndrome be a living kidney donor?

It depends on individual health status and kidney function. Some Nutcracker Syndrome patients may be ineligible due to vascular abnormalities or concerns about kidney resilience after donation, but many individuals with Nutcracker Syndrome may be eligible to donate a kidney. A transplant team will evaluate each case carefully.

What should I do if my doctor has recommended therapeutic nephrectomy, and I want to donate my kidney to someone?

Speak to your transplant team about the possibility of becoming a living kidney donor. You can also register with the National Kidney Registry to start the donation process and see if you qualify. The National Kidney Registry can also provide more information and help you find a center that provides education, treatment options, and specialized care for Nutcracker Syndrome patients.