Toward Automation of the Supine Pressor Test for Preeclampsia

Abstract Preeclampsia leads to increased risk of morbidity and mortality for both mother and fetus. Most previous studies have largely neglected mechanical compression of the left renal vein by the gravid uterus as a potential mechanism. In this study, we first used a murine model to investigate the pathophysiology of left renal vein constriction. The results indicate that prolonged renal vein stenosis after 14 days can cause renal necrosis and an increase in blood pressure (BP) of roughly 30 mmHg. The second part of this study aimed to automate a diagnostic tool, known as the supine pressor test (SPT), to enable pregnant women to assess their preeclampsia development risk. A positive SPT has been previously defined as an increase of at least 20 mmHg in diastolic BP when switching between left lateral recumbent and supine positions. The results from this study established a baseline BP increase between the two body positions in nonpregnant women and demonstrated the feasibility of an autonomous SPT in pregnant women. Our results demonstrate that there is a baseline increase in BP of roughly 10–14 mmHg and that pregnant women can autonomously perform the SPT. Overall, this work in both rodents and humans suggests that (1) stenosis of the left renal vein in mice leads to elevation in BP and acute renal failure, (2) nonpregnant women experience a baseline increase in BP when they shift from left lateral recumbent to supine position, and (3) the SPT can be automated and used autonomously.

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Ultrasound Characteristics of the Nutcracker Syndrome

Archive of Clinical Medicine ◽

10.21802/acm.2018.2.9 ◽

2018 ◽

Vol 24 (2) ◽

Author(s):

Ihor Kobza ◽

Irena Nesterenko ◽

Volodymyr Nesterenko

Keyword(s):

Blood Flow ◽

Renal Vein ◽

Doppler Ultrasonography ◽

Color Doppler ◽

Left Renal Vein ◽

Peak Systolic Velocity ◽

Gonadal Vein ◽

Critical Stenosis ◽

Vein Stenosis

The article presents the results of color Doppler ultrasonography of the left renal vein and gonadal vein with the determination of the peak systolic velocity of blood flow and abnormal blood reflux in patients with left-sided varicocele. The objective of the research was to compare preoperative ultrasound characteristics of the left renal vein, left gonadal vein, peak systolic velocity of blood flow and the presence of abnormal blood reflux, the formation of ultrasound criteria for the selection of patients for surgical correction of phlebohypertension. Results. Ultrasound signs of aorta mesenteric compression were absent in 24 (24.5%) patients; the signs of aorta mesenteric compression without critical left renal vein stenosis were observed in 64 (65.3%) patients; critical stenosis of the left renal vein was diagnosed in 10 (10.2 %) patients. The patients with critical stenosis of the left renal vein underwent left renal vein transposition. Conclusions. Ivanissevich surgery with prognostically low risk of relapse is recommended for the patients with left-sided varicocele without any signs of aorta mesenteric compression. Patients with the signs of aorta mesenteric compression require clear determination of the degree of left renal vein stenosis. We consider the transposition of the left renal vein to be indicated in case of critical stenosis when the correlation of the diameters of the distal and proximal segments of the left renal vein is ≥ 3 and the ratio of peak systolic velocities in the proximal and distal segments is ≥ 6. Thus, the diagnosis of phleborenohypertension in the patients with varicocele by means of color Doppler ultrasonography with the determination of blood flow velocity indicators in the left renal vein circulation and the determination of the critical stenosis of the left renal vein is decisive in choosing the surgical method of treatment. This provides an opportunity to evaluate the cause of varicocele occurrence and choose the optimal method of surgical treatment.

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TREATMENT OF AORTA MESENTERIC COMPRESSION: CURRENT PROBLEMS AND PROSPECTS

Art of Medicine ◽

10.21802/artm.2021.3.19.36 ◽

2021 ◽

pp. 36-42

Author(s):

I. R. Nesterenko

Keyword(s):

Ct Angiography ◽

Doppler Ultrasound ◽

Renal Vein ◽

Color Doppler ◽

Left Renal Vein ◽

Clinical Manifestations ◽

Color Doppler Ultrasound ◽

Nutcracker Syndrome ◽

Pelvic Organs ◽

Vein Stenosis

Left renal vein compression between the aorta and the superior mesenteric artery at an acute angle of the origin of the latter (“the nutcracker syndrome”) often leads to phlebohypertension in the left renal vein causing a combination of structural and functional changes in the kidneys and pelvic organs, different clinical manifestations such as left-sided varicocele, hematuria, pelvic venous congestion syndrome, the development of renal failure. The objective of the research: to determine indications for surgical and conservative treatment of aorta mesenteric compression. Materials and methods. The study included 210 patients (142 men and 68 women) with suspected “nutcracker syndrome” who were referred to vascular surgeons for a consultation by urologists and gynecologists during the period from 1999 to 2020, mainly from the western regions of Ukraine (about 11 million population). The age of the patients ranged from 12 to 52. All patients were interviewed for specific complaints: pain in the left lumbar region and left half of abdomen, inability to eat large amounts of food, hematuria, proteinuria, hemospermia, erectile dysfunction, left sided varicocele in men, and left sided pudendal varicosity and dysmenorrhea in women. All referred patients with suspected “nutcracker syndrome” underwent color Doppler ultrasound to determine the presence of pathological reflux in the left renal and gonadal veins by measuring peak systolic velocities in order to confirm or exclude that pathology. The patients with confirmed left renal vein stenosis underwent CT angiography. Results. According to color Doppler ultrasound, different degree of aorta mesenteric compression was confirmed in 138 (65.7%) patients (83 men and 55 women), critical left renal vein stenosis was observed in 35 of them. Two patients were diagnosed with the retroaortic left renal vein (“posterior nutcracker”). According to observations, clinical manifestations of AMC syndrome severe forms occurred in case of an increase in the diameter of the distal part of the LRV compared to its proximal segment by 3-6 times as well as in case of an increase in peak systolic velocity in the stenosed proximal segment by 6-14 times (by 8.7 times on average) compared to the left renal vein distal segment. Conclusions. Color Doppler ultrasound with determination of peak systolic velocities and diameters of the left renal and gonadal veins, pathological reflux in them must be the obligatory diagnostic stage in the patients with suspected AMC. The choice of treatment approach should be made taking into account clinical and laboratory indices, as well as the assessment of AMC severity according to instrumental data (ultrasound, CT angiography, MRA, etc.). The severity of pathomorphological changes in the pelvic organs and their consequences proves the need to eliminate phlebohypertension in the left renal and gonadal veins. LRV transposition proves its effectiveness in the remote postoperative period.

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V484: Laparoscopic Spleno-Renal Venous Bypass for Left Renal Vein Nutcracker Syndrome

The Journal of Urology ◽

10.1016/s0022-5347(18)32151-7 ◽

2007 ◽

Vol 177 (4S) ◽

pp. 161-162

Author(s):

Benjamin I. Chung ◽

Monish Aron ◽

Nicholas J. Hegarty ◽

Inderbir S. Gill

Keyword(s):

Renal Vein ◽

Left Renal Vein ◽

Nutcracker Syndrome ◽

Venous Bypass

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1847: Bipolar Coagulation for Clipless Division of Left Renal Vein Branches During Laparoscopic Living Donor Nephrectomy

The Journal of Urology ◽

10.1016/s0022-5347(18)39039-6 ◽

2004 ◽

Vol 171 (4S) ◽

pp. 488-488

Author(s):

Marcelo A. Orvieto ◽

Gary W. Chien ◽

Arieh L. Shalhav

Keyword(s):

Renal Vein ◽

Living Donor ◽

Left Renal Vein ◽

Donor Nephrectomy ◽

Bipolar Coagulation ◽

Living Donor Nephrectomy

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Pelvic congestion syndrome and left renal compression syndrome - clinical features and therapeutic approaches

VASA ◽

10.1024/0301-1526/a000538 ◽

2016 ◽

Vol 45 (4) ◽

pp. 275-282 ◽

Cited By ~ 8

Author(s):

Christina Jeanneret ◽

Konstantin Beier ◽

Alexander von Weymarn ◽

Jürg Traber

Keyword(s):

Varicose Veins ◽

Left Renal Vein ◽

Standing Position ◽

Ovarian Vein ◽

Pelvic Congestion Syndrome ◽

Compression Syndrome ◽

Abstract Knowledge ◽

Increased Risk ◽

Definition Of ◽

Pelvic Congestion

Abstract. Knowledge of the anatomy of the pelvic, gonadal and renal veins is important to understand pelvic congestion syndrome (PCS) and left renal vein compression syndrome (LRCS), which is also known as the nutcracker syndrome. LRCS is related to PCS and to the presence of vulvar, vaginal and pudendal varicose veins. The diagnosis of the two syndromes is difficult, and usually achieved with CT- or phlebography. The gold standard is the intravenous pressure measurement using conventional phlebography. The definition of PCS is described as pelvic pain, aggravated in the standing position and lasting for more than 6 months. Pain in the left flank and microhaematuria is seen in patients with LRCS. Women with multiple pregnancies are at increased risk of developing varicose vein recurrences with pelvic drainage and ovarian vein reflux after crossectomy and stripping of the great saphenous vein. The therapeutic options are: conservative treatment (medroxyprogesteron) or interventional (coiling of the ovarian vein) or operative treatment (clipping of the ovarian vein). Controlled prospective trials are needed to find the best treatment.

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The desperate plea of women with the nutcracker syndrome

Phlebologie ◽

10.1055/s-0037-1622296 ◽

2010 ◽

Vol 39 (02) ◽

pp. 104-111

Author(s):

J. L. Villavicencio

Keyword(s):

Renal Vein ◽

Imaging Techniques ◽

Left Renal Vein ◽

Diagnostic Tools ◽

Nutcracker Syndrome ◽

Treatment Techniques ◽

Children And Young Adults ◽

Good Number ◽

Pelvic Congestion

Summary Objective: To increase awareness on the severe impact of the nutcracker syndrome in women with undiagnosed disease. Patients and methods: We reviewed the medical literature and analyzed six representative series with 73 patients with nutcracker syndrome. Women with left flank pain, dyspareunia, dysuria, dysmenorrhea, micro- or macrohaematuria and pelvic congestion symptoms, should be carefully investigated for evidence of meso aortic left renal vein compression. A good number of our colleagues do not believe in the existence of the nutcracker syndrome and send these patients in a long pilgrimage in search of someone who can help them to get relief to their pain. New and improved imaging techniques can assist in the diagnosis but retrograde reno-gonadal phlebography and renocaval gradient are the most reliable diagnostic tools. Results: Among an assortment of treatment techniques, renal vein transposition and endovenous stenting were the two most commonly used procedures. There are no long term studies on renal vein stenting in children and young adults. Its use in these cases should be carefully considered. The nutcracker syndrome may present with pelvic congestion symptoms and its diagnosis missed. The patient's age, severity of symptoms and haemo dynamic renal studies should guide the treatment. Conclusion: An increased awareness of the existence of the nutcracker syndrome may prevent many unfortunate undiagnosed women from spending many months and often years of suffering.

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The nutcracker phenomenon of the left renal vein (NCP) – improved understanding as “midline congestion syndrome“ by dynamic color-Doppler sonographic tissue perfusion measurement

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/s-2007-988867 ◽

2007 ◽

Vol 28 (S 1) ◽

Author(s):

T Scholbach

Keyword(s):

Renal Vein ◽

Color Doppler ◽

Left Renal Vein ◽

Tissue Perfusion ◽

Perfusion Measurement ◽

Nutcracker Phenomenon

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ASSESSMENT OF THE PLATELET COUNT IN THE PREGNANT WOMEN IN IGIMS, PATNA, BIHAR

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i2.1185 ◽

2020 ◽

Vol 4 (2) ◽

Author(s):

Tanwi Singh ◽

Anshuman Sinha

Keyword(s):

Platelet Count ◽

Pregnant Women ◽

Screening Test ◽

Low Cost ◽

Medical Science ◽

Cost Effective ◽

Platelet Indices ◽

Increased Risk ◽

Low Platelet Count ◽

Severity Of The Disease

The major risk associated with low platelet count in pregnancy is the increased risk of bleeding during the childbirth or post that. There is an increased blood supply to the uterus during pregnancy and the surgical procedure requires cutting of major blood vessels. Women with thrombocytopenia are at increased risk of losing excessive blood. The risk is more in case of caesarean delivery as compared to vaginal delivery. Hence based on above findings the present study was planned for Assessment of the Platelet Count in the Pregnant Women in IGIMS, Patna, Bihar. The present study was planned in Department of Pathology, Indira Gandhi Institute of Medical Science, Patna, Bihar, India. The present study was planned from duration of January 2019 to June 2019. In the present study 200 pregnant females samples received for the platelet estimation were enrolled in the present study. Clinically platelet indices can be a useful screening test for early identification of preeclampsia and eclampsia. Also platelet indices can assess the prognosis of this disease in pregnant women and can be used as an effective prognostic marker because it correlates with severity of the disease. Platelet count is a simple, low cost, and rapid routine screening test. Hence the data generated from the present study concludes that platelet count can be used as a simple and cost effective tool to monitor the progression of preeclampsia, thereby preventing complications to develop during the gestational period. Keywords: Platelet Count, Pregnant Women, IGIMS, Patna, Bihar, etc.

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Pathological features of the sequence in pregnant women with delayed fetal growth

HEALTH OF WOMAN ◽

10.15574/hw.2019.140.50 ◽

2019 ◽

pp. 50-54

Author(s):

V.O. Golyanovskiy ◽

◽

Ye.O. Didyk ◽

Keyword(s):

Pregnant Women ◽

Intrauterine Growth Restriction ◽

Normal Development ◽

Intrauterine Infection ◽

Normal Pregnancy ◽

Growth Restriction ◽

Control Group ◽

Intrauterine Growth ◽

Increased Risk ◽

Infection And Inflammation

Pregnant women with intrauterine growth restriction (IUGR) have an increased risk of adverse perinatal and long-term complications compared with the birth of children with normal body weight. Thus, IUGR is one of the main challenges for the global health system, especially in poor and developing countries. Morpho-functional studies of the placentas help in determining the causes of IUGR, and therefore, timely prevent complications in pregnant women with IUGR. The objective: The purpose of this study is to investigate various morphometric and pathomorphological changes in the placenta, including inflammatory, in cases of IUGR, and to establish a correlation of these results with the etiology and complications for the fetus. Materials and methods. In the current study, 54 placentas of the fetuses with IUGR (the main group) were compared with 50 placentas of the fetuses with normal development (control group). The criteria for the inclusion of IUGR were gestational age more than 30 weeks and all fetuses with a weight less than 10th percentile for this period of pregnancy. The placenta material was studied pathomorphologically with laboratory screening for infection and inflammation. Similarly, the results were determined for placentas of the fetuses with normal development compared to placentas with IUGR. Results. The placenta study showed the presence of calcification in the case of IUGR, as well as in the case of prolonged pregnancy. However, calcification of the placenta in the case of IUGR was more progressive compared with placenta in the normal pregnancy. In addition, the presence of intrauterine infection and inflammation was observed, which could also lead to an adverse outcome for the further progression of pregnancy with IUGR. Conclusion. A comparative macro- and microscopic pathomorphological study of the placentas in the two groups has shown a significant increase in the pathological changes in all the anatomical structures of the fetuses with IUGR. Key words: Intrauterine growth restriction (IUGR), fetal weight, pathomorphological changes of the placenta.

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