The protagonist of today's case is a female patient, 34 years old, surnamed Liang.
2 years ago, Ms. Liang found herself with low back pain, mainly left side low back pain, difficult to alleviate, at first thought it was muscle strain, because of work reasons, Ms. Liang worked for a long time, often back pain, but that time the low back pain lasted for nearly 2 months, and then got better for a while, but soon after began to have low back pain.
And this time the low back pain also radiated to the left hip, the left thigh, can't help it, this must be a lumbar spine problem. Ms. Liang thought to herself.
So I found an orthopedic doctor, and the orthopedic doctor listened to Ms. Liang's description and basically agreed that there was a problem with the lumbar spine.
If the lumbar disc is protruding, it will compress the nerves, especially those who work by bending down or sitting for a long time, Ms. Liang is like this, compressing the nerves will lead to low back pain, which is the most common symptom of lumbar disc herniation. There is also sciatica.
The orthopedic doctor explained that the sciatic nerve is easily affected by the lumbar disc herniation, sciatica is more gradual, at first there is not, and then gradually appeared, Ms. Liang's situation is also in line with, the pain is radioactive, from the buttocks, the lateral thighs, the lateral heels of the lower legs or the back of the feet may appear pain.
Ms. Liang had low back pain at first, and then there was pain in her left hip, thigh, and even sometimes a sneeze could exacerbate the pain, and the orthopedic surgeon said that a simple plain X-ray could be done.
The results came out, and there was indeed a degenerative lesion of the lumbar intervertebral disc. Fortunately, I came to the orthopedic doctor earlier, and if I had been treated according to the lumbar muscle strain, I might have delayed it.
Do you want surgery? Ms. Leung was worried.
Temporarily do not use surgery, first conservative treatment, orthopedic doctor said, bed rest, put the work at hand, try to lie in bed for half a month, with a waist circumference gradually down to the ground activities. Then prescribe some anti-inflammatory analgesics. At the same time, traction therapy, pelvic traction is the most commonly used, and the effect is good.
Ms. Liang was hospitalized for 2 weeks, physiotherapy and traction every day, and felt that her low back pain was indeed better.
discharge.
After this time, Ms. Liang changed a job, which was simpler, could have more rest time, and always paid attention to avoiding damage to the waist muscles or lumbar spine, but she did not expect that the old disease had recurred.
This time, the low back pain was even worse than before, and I vaguely felt that my left lower abdomen was also painful. What scared Ms. Liang even more was that after cooking in the evening, she pulled a pee once, and she was slightly red.
Originally, Ms. Liang was worried about whether the low back pain would be a kidney problem, such as kidney deficiency or something, so that she was more worried. I thought I would go to the hospital the next day to check it out, but I didn't expect that the urine was clear again the next day, as if nothing had happened.
At the urging of her husband, she still went to the hospital.
Did the urine routine, a look, urine red blood cells 3+.
Yes, There is really blood in Ms. Liang's urine.
What's going on? Bad kidneys? Shouldn't it be uremia? Can't stop thinking.
Don't worry, the most common condition of blood in the urine is inflammation, such as kidney stones, ureteral stones or inflammation caused by infection, and the capillaries of the lining of the urinary tract are broken, so there will be red blood cells flowing out. The doctor explains.
Further do a urinary tract ultrasound.
The color ultrasound results came out, no kidney stones, no ureteral stones, not a problem with stones. In addition to ms. Liang's positive urine red blood cells, there is no obvious urgency and urinary pain and frequency, which is not suitable for urinary tract infection.
There's no cancer, right? Like bladder cancer, or cancer in other parts of the urinary tract? In the early days, the color ultrasound may not be able to see it, it is best to do a CT, cystoscopy, and look more carefully.
Ms. Liang thought that she had low back pain, lower abdominal pain, and hematuria, and really had to consider urinary tract diseases, if it was really cancer, it would be troublesome, so the doctor's recommended tests were agreed.
The CT was done, no obvious lesions were found, and there was a slight relief.
Then there was the cystoscope, which was a little uncomfortable, but also did, the mirror entered from the urethra, into the bladder, and the mucous membranes seen all the way were smooth and clean, with no signs of cancer.
This is reassuring.
The problem is that after several re-examinations of the urine routine, there are still urine red blood cells 3+ ah.
Ms. Liang remembered that she had done a physical examination 2 years ago, rummaged through the boxes and cabinets to find the report, Oh my God, at that time, the urine routine was also urine red blood cell 3+, how did she ignore this abnormal result at that time, confused.
Ms. Liang later saw a nephrologist, the doctor suggested doing a kidney biopsy, the patient has low back and abdominal pain, as well as hematuria, not excluding glomerulonephritis, but this disease is a series, there are many types, and a kidney biopsy is required to confirm the diagnosis.
But the kidney biopsy is traumatic, the thought of such a thick needle to penetrate their kidneys, Ms. Liang's legs are weak, and finally refused this operation, first conservative treatment, take some medicine.
The doctor also agreed that even if it is some nephritis nephropathy, it should not be serious, because the patient's blood creatinine is still normal, the blood pressure is not high, agree to conservative treatment, prescribe some kidney protection drugs.
After eating for more than 1 month, the low back pain still occurred intermittently during the period, but it was quite bearable. I went back to the orthopedic surgeon before and suggested that I do a lumbar MRI, and as soon as the results came out, Ms. Liang was confused again.
Lumbar MRI results show that although there is a bit of lumbar disc herniation, it is not serious, it is not enough to compress the nerves, it will not cause such obvious low back pain, and it is even more unlikely to cause hematuria.
Or will go to the nephrologist, not an orthopedic problem. The orthopedic surgeon said helplessly.
But the drug given by the nephrologist is not good.
The husband also went around to find a doctor, and later found the local traditional Chinese medicine hospital, the doctor evaluated, thought that it was in line with the kidney deficiency evidence, gave a lot of drugs, let continuously eat for 2 months.
It was a very bitter drug, but for the sake of health, Ms. Liang still pinched her nose and drank it, looking forward to this time to be good.
Whether Chinese medicine has an effect, it is difficult to say, sometimes it seems to be better, but soon the waist pain came again, and it is not clear whether there is an effect in the end.
Half a year later, Ms. Liang went to the hospital again to review the urine routine, and still had urine red blood cells 3+.
She was about to cry.
During this time she has been looking for relevant treatment on the Internet, positive urine blood may involve many diseases, the most serious consequence is uremia, once into uremia, all organs of the body will be affected, the heart is not good, the lungs are not good, the whole person will be bad, and finally to receive long-term hemodialysis, people will be fixed in the hospital.
The doctor told her that she should either have a kidney puncture and see what was going on with her kidneys.
Ms. Liang hesitated.
After thinking about it, I decided to agree to the doctor's arrangement and be hospitalized.
After being hospitalized, Ms. Liang told the tube bed doctor that the recent menstruation is not good, painful menstruation is frequent, always feel uncomfortable in the lower abdomen, I hope to ask a gynecologist to consult to see, do you want to take some medicine, adjust some and then kidney puncture.
The obstetrician and gynecologist came and asked some questions. Ms. Liang's dysmenorrhea problem has actually existed very early, but it is also good and bad, and it has been more severe in the past few months, and the pain is so bad that it can't stand up straight.
After some examinations, the gynecologist concluded that there was pelvic congestion, and even chronic pelvic inflammatory disease, and there would be repeated lower abdominal pain. Chronic pelvic inflammatory disease is mostly a bacterial infection, which may be related to frequent sexual life, we can often use some antibiotics, in addition, do not have intercourse, slow down, pelvic inflammatory disease recovery is also helpful.
When it comes to the issue of the same room, Ms. Liang wants to stop talking.
Finally told the doctor, in fact, this half a year has not been how to have sex, because every time will be more painful, uncomfortable, but also because of this problem has been disputed, and even seen Chinese medicine, conditioning, no help.
This is a bit strange, in general, chronic pelvic inflammatory disease is a sexually active woman of childbearing age, if you have not had sex for a long time, it is reasonable to say that it should not be.
Maybe the so-called pelvic inflammatory disease is not pelvic inflammatory disease, it may still be a kidney problem. Low back pain and lower abdominal pain caused by kidney disease are more likely.
The problem was thrown back to the nephrologist.
On this day, the director of the Department of Nephrology rounded the room, heard that the gynecologist came to see, and left, and thought that it was not a gynecological problem, so he felt strange.
The tube bed doctor is also helpless, the patient repeatedly waist and abdominal pain, urine blood positive, but the kidney function is still normal, CT, cystoscopy also did, did not find any abnormalities, ready to do kidney puncture. And the patient said to adjust the gynecological problem before doing it, and now the gynecologist says that it may not be a gynecological problem.
Stuck in an endless cycle.
The director's brow also wrinkled, and said slowly, kidney puncture can be slowed down first, first give the patient a renal vein vascular ultrasound, look at the kidney vein situation, especially the left renal vein.
Director, I have done kidney ultrasound twice, Liang Busy said.
It's not the same, what you do is kidney color ultrasound, is to see the kidney, I now want you to do kidney vein color ultrasound, is specifically to see the size of the kidney vein, through, the general doctor will not specifically look at this, unless we ask.
The tube bed doctor smelled this and suddenly realized, the director is suspected that the patient's kidney blood vessels are wrong?
Do the examination first, the renal vascular ultrasound is non-invasive, can be done repeatedly, if you can't see clearly, do CTA angiography, it is also a small trauma, are more comfortable than directly doing renal puncture. The director said, and then ended the rounds.
In the afternoon of the same day, Ms. Liang was arranged to do kidney vein ultrasound.
The doctor who did the color ultrasound was a young doctor, and after he saw Ms. Liang's kidney vein condition, he was a little surprised and quickly invited the teacher to come and see it together.
The two doctors of the ultrasound department repeatedly compared, calculated, and finally came to a conclusion, and Ms. Liang's left kidney vein was clamped.
Caught? Ms. Liang was puzzled.
That's right, your left renal vein is caught by the angle formed by the abdominal aorta and the superior mesenteric artery, and it is pinched, the narrowest lumen is only 2mm, while the posterior dilated lumen is 10mm, a big gap.
I put a picture to understand this anatomical relationship:
As shown above, the left renal vein is sandwiched by two arteries, and the left renal vein of a normal person also passes through this angle, but it will not be clamped by death, because there will be a lot of soft tissue around the vein, and the blood flow back to the left deep vein is very smooth. However, in rare cases, the patient's left renal vein will be flattened due to congenital poor development, or the patient is too thin, or for other reasons.
It's like this walnut:
This is a condition in which the left renal vein is clamped between two arteries, which we call the "nutcracker phenomenon" (left renal venous compression syndrome).
The results were quickly reported to the internist.
The director of the Department of Nephrology looked at it and sighed, and sure enough, as expected. I almost stabbed someone's kidney.
You have nutcracker syndrome, not a kidney disease, not a lumbar spondylosis. Your left kidney vein is clamped by people deadly, the blood return of the left kidney vein is not smooth, it will accumulate in the kidney, the blood vessels in the kidney will expand, and after a long time, it will rupture, then the red blood cells will leak out and mix into the urine. There are also some patients who will leak protein, resulting in positive protein in the urine.
Due to long-term congestion of the kidneys, there may also be repeated manifestations of low back pain. And it is only limited to the left kidney left waist pain, the right side is not affected.
What's more insidious is that in addition to kidney, hematuria, and low back pain, your gynecological problems can also be explained. The director said.
Ms. Liang did not understand.
Look at this diagram to understand:
As shown in the figure above, the left ovarian vein (male is the left testicular vein) is also integrated into the left renal vein, if the left renal vein is compressed, it is bound to cause the left ovarian vein to dilate and congestion, for a long time, it will also lead to congestion near the patient's left ovary, and dysfunction, which may explain the patient's pelvic pain, painful intercourse. This is what Ms. Liang called the gynecological problem.
The source of everything is because the left kidney vein is compressed.
Low back pain, lower abdominal pain, hematuria, gynecological diseases, are all caused by a disease. Instead of the previously thought psoas muscle strain, lumbar disc herniation, gynecological diseases, other nephritis nephropathy.
In order to further clarify the diagnosis, the director suggested that the CTA of the renal blood vessels be done, direct contrast, and see more clearly, that is, the left renal vein is compressed.
This disease is too rare, right? Ms. Liang's heart palpitated.
Rare, does not mean there is none. Many patients with unexplained hematuria may eventually be caused by this disease, and we must be vigilant. The director told the young doctor not to rush to do a kidney puncture, so as not to get an unnecessary injection. Keep more eyes, when doing kidney ultrasound, let the doctor look at the kidney veins together.
So why do I have this disease? It used to be good.
It may be a problem of congenital development, symptoms are gradually appearing, some people are very young, such as teenagers, there are also adults who have symptoms. It's not an emergency, it's not urgent, but it's hard to deal with.
In theory, the treatment measure is very simple, is not the left kidney vein is compressed, let it go?
It's easy to say, it's hard to do. To loosen it, you have to operate. The operation is either to cut off a section of reconnection, or to make a detour around the blood vessels, which is not easy, and there will be complications, as well as doing internal and external stents to open, it is not an easy task. If the symptoms are not obvious, the patient can still accept, generally we do not recommend surgery, first conservative treatment.
How else can I be treated conservatively?
Eat fat.
Trying to gain weight and increase the abdominal fat may increase the fat around the left kidney vein, it is possible to open the angle and release the oppressed left kidney vein, which will heal without medicine. The director said.
Listening to this, Ms. Liang is happy and unhappy, happy that there is no need to use the knife, unhappy is to gain weight, to know how much effort she spent to lose so many kilograms, now to work hard to gain weight, aesthetics must be compromised.
Do you have to increase the weight? Ms. Liang asked.
It's not easy to say, it may take ten kilograms, or even more, inconclusive, individual differences, and even some people have no effect after gaining weight, but at least there is an opportunity to try it. The director said comfortingly.
That's all there is to it.
Half a year later, Ms. Liang weighed 65kg, half a year ago it was 55kg, and suddenly weighed 10kg, not to mention, since gaining weight, waist pain seems to have really decreased. But the urine routine that went to the hospital for review, the urine red blood cells are still positive, and there are 2+, which have not completely disappeared.
The renal venous ultrasound on the re-examination also found that the left renal vein was still in a state of compression, but the narrowest part was improved.
The director said that it may still have to gain weight, and if the effect is not good in the future, it may have to be operated on.
But that's a story.
(End of this article)
Since I did medical science, there will be many patients to provide me with various cases, this case is also provided by patients, just these two days someone mentioned this disease, so I shared this case, hoping to help some people.