A case of secondary hypertension associated with the nutcracker phenomenon.

Abstract

A 25-year-old Korean woman was referred for uncontrolled hypertension. Laboratory

examination revealed increased plasma renin activity and microscopic hematuria.

Computed tomography demonstrated compression of the left renal vein (LRV) between

the aorta and superior mesenteric artery; however, both renal arteries were

intact and there was no adrenal mass. Renal vein catheterization showed external

compression with a pressure gradient of up to 8 mm Hg between the LRV and the

inferior vena cava. Plasma renin activity in the LRV was almost five times higher

than that in the right renal vein. In this patient, renin-dependent hypertension

was caused by renal congestion due to LRV obstruction.