Abstract
Nutcracker syndrome must be taken into consideration in the differential diagnosis of hematuria and orthostatic proteinuria. When these urine abnormalities are seen, clinicians should never forget about nutcracker syndrome as a possible diagnosis, especially in the case of left flank pain or varicocele.
Doppler ultrasound performed by an experienced radiologist is the first line diagnostic approach. Establishing the diagnosis may save patients from invasive procedures like kidney biopsy or cystoscopy.
Conservative management is the preferred approach, surgery should be indicated only in severe cases. We present a case of a boy with intermittent macroscopic hematuria in whom doppler ultrasound of the left renal vein clarified the etiology of hematuria.