Monday, June 22, 2020

Two causes of "hematuria" in children-dragon fruit and nutcracker​​

The urology clinic is a small market, and many people are sick. Some parents came in anxiety, spent money, registered, and waited for an hour to line up to see a doctor. The doctor checked the child and said that your child is okay. Go back. sweat! I have recently encountered two cases of such hematuria patients in the clinic, and share with you.

The first child came for a day because of hematuria. When the parents brought their children to Beijing to play, they found that the children were suddenly urinating for red urine. The parents then refunded the plane tickets and quickly took the children to the hospital for examination. The outpatient examination showed that the child had no discomfort and had a routine urine test. All results were normal. Asked about the medical history, the child ate a red dragon fruit yesterday.

The cause was found, false hematuria caused by dragon fruit. Fruits such as dragon fruit, strawberry, and tomato contain a large amount of anthocyanins. Everyone metabolizes this anthocyanin differently. If someone does not metabolize completely, red urine will appear, but this red is not blood. There is no harm to the human body, so, a false alarm.

The second child is older and has gone to middle school. The child intermittently found hematuria for a month. A month ago, when the child was urinating, he accidentally found red hematuria, but he didn't dare to tell his parents that he had hematuria again recently, and the parents brought the child to the doctor for treatment. The outpatient examination of the child did not cause any discomfort. The outpatient laboratory routine urine test did indeed have a lot of red blood cells in the urine, and urine protein was also positive. So doing a urinary system and vascular ultrasound, suggesting that the child is nutcracker syndrome.

Nutcracker syndrome is the left renal vein compression syndrome. The abdominal aorta and the superior mesenteric artery form an angle of 40 to 60 degrees. The left renal vein just passes through this angle and looks like it has entered a nutcracker. From the anatomical point of view, the right renal vein is directly injected into the inferior vena cava, and the stroke is short and straight. The left renal vein needs to pass through the angle between the abdominal aorta and the mesentery, and can be injected into the inferior vena cava across the front of the abdominal aorta, so the left renal vein is much longer than the right renal vein.

Normally, the angle between the superior mesenteric artery and the abdominal aorta is filled with mesenteric fat, lymph nodes, and peritoneum, so that the left renal vein is not compressed. In the case of rapid puberty development, rapid growth of height, excessive extension of the spine, sharp changes in shape or renal prolapse, venous blood flow is blocked, causing left renal venous hypertension, also known as the nutcracker phenomenon.

In 1950, El-Sadr and Mina first described the phenomenon of left renal vein compression. In 1972, Belgian doctor DeSchepper retained urine through a cystoscopy, and confirmed that compression of the left renal vein can cause left renal bleeding and the disease Named "Nutcracker Syndrome".

The disease looks complicated, but most children do not need treatment. Continue to observe, eat fat, slowly just fine. Some incentives (such as strenuous exercise, cold) can induce hematuria or recurrence of hematuria, so children should be advised to avoid strenuous exercise and prevent colds.

However, for patients with repeated hematuria, anemia, severe varicocele, or low back pain, especially adult patients, who have not been relieved after more than 2 years of observation or symptomatic medical treatment, or have backache, dizziness, fatigue, and renal impairment, may Consider surgical treatment.

Therefore, don't panic when you encounter hematuria, and learn some knowledge to see if it is real hematuria or false hematuria. Even if it is real hematuria, you need to know if you need treatment.

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