Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2025; 22 (1): 1-114 ➤ Особенности ультразвуковой диагностики компрессии левой почечной вены и ренальной флебогипертензии

Features of ultrasound diagnostics of left renal vein compression and renal phlebohypertension

Authors: Shumilina M.V., Mamalyga M.L.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2025-22-1-47-59

UDC: 616.149-008.341.1-073.43

Link: Clinical Physiology of Blood Circulaiton. 2025; 22 (1): 47-59

Quote as: Shumilina M.V., Mamalyga M.L. Features of ultrasound diagnostics of left renal vein compression and renal phlebohypertension. Clinical Physiology of Circulation. 2025; 22 (1): 47–59. DOI: 10.24022/1814-6910-2025-22-1-47-59

Keywords:  aortomesenteric compression Nutcracker syndrome venous pressure gradient arterial hypertension varicocele

Received / Accepted:  13.01.2025 / 23.01.2025

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Abstract

Objective– to optimize ultrasound diagnostics of left renal vein compression and renal phlebohypertension.

Material and methods. 44 patients with compression of the left renal vein (LRV) were prospectively examined. Inclusion criteria: the presence of geometric signs of compression; anteaortic location of the LRV. Exclusion criteria: the presence of signs of pathology of the aorta, kidneys and renal arteries. All patients underwent ultrasound to determine the structure of the renal arteries and veins, and the superior mesenteric artery (SMA); measurement of the venous pressure gradient (∆VP) in the compression area; the size of both kidneys; peripheral resistance indices IR and PI on segmental arteries bypassing the kidneys. The R environment (version 4.2.1) with the integrated RStudio development environment was used for statistical data analysis.

Results. Arterial hypertension was detected in 79%, pain in the left iliac region/back – 73%, varicocele – 65%, hematuria – 40%. Classical aortomesenteric compression (S. Nutcracker) was observed in 26% of cases, in 74% – combined compression of LRV by the SMA, renal arteries and aorta. ∆VP ≥ 5 mmHg was detected only in 25 (54.5%) patients with a predominance of the length and peripheral resistance indices of the left kidney over those of the right kidney (p <0.001). A high risk of renal phlebohypertension was found with a PI ratio of the right to left renal artery < 0.96 and a ratio of the length of the right and left kidneys < 0.97 (AUC = 0.977; 95% CI: 0.929 – 1,000, p < 0.001) with a diagnostic accuracy of 95.5%.

Conclusion. With gonadal vein phlebectasia and advanced collateralization, there is no ∆VP in the compression zone. With high ∆ VP in the LRV compression zone ≥ 5 mmHg, the length of the left kidney and peripheral resistance indices increased compared with the parameters of the right kidney.

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About Authors

  • Margarita V. Shumilina, Dr. Med. Sci., Head of the Department, Ultrasound Diagnostics doctor, Professor of the Department of Cardiology, Ultrasound and Functional Diagnostics with a course in Pediatric Cardiology, ORCID
  • Maxim L. Mamalyga, Dr. Med. Sci., Leading Researcher; ORCID

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