Relationship between Microscopic Hematuria and Inferior Vena Cava Reflux on Color Doppler Ultrasonography

Kimio Sugaya, Saori Nishijima, Katsumi Kadekawa, Katsuhiro Ashitomi

Department of Urology, Kitakami Central Hospital, Okinawa, Japan.
Southern Knights’ Laboratory LLP, Okinawa, Japan.

DOI: 10.4236/oju.2013.38056                

Abstract

We examined the relationship between microscopic hematuria and inferior vena cava (IVC) reflux. Transabdominal color Doppler ultrasonography of the IVC was performed in the supine position with the convex probe positioned perpendicular to the upper abdominal wall, and the extent of reflux into the IVC with each heart beat was examined near the diaphragm. A total of 171 patients were studied who had no diseases that could cause hematuria, and no symptomatic gross hematuria. The relationship between the existence and severity of IVC reflux and urine occult blood was examined. The 98 males included 50 subjects without IVC reflux and 48 with reflux, while the 73 females included 24 without IVC reflux and 49 with IVC reflux, respectively. The occurrence of IVC reflux was unrelated to age, but the prevalence of reflux was significantly higher in females than males. As the grade of IVC reflux increased, there was an increase in the prevalence and the severity of hematuria in both males and females. In conclusion, IVC reflux could be related to the occurrence of microscopic hematuria. Renal or urinary tract congestion secondary to IVC reflux may be one of the factors contributing to hematuria.

Keywords

Inferior Vena Cava Reflux; Ultrasonography; Hematuria

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	D. Russo, R. Minutolo, V. Iaccarino, M. Andreucci, A. Capuano and F. A. Savino, “Gross Hematuria of Un-common Origin: The Nutcracker Syndrome,” American Journal of Kidney Diseases, Vol. 32, No. 3, 1998, p. E3. http://dx.doi.org/10.1053/ajkd.1998.v32.pm10074588
[2]	A. de Schepper, “Nutcracker Phenomenon of the Renal Vein and Venous Pathology of the Left Kidney,” Journal Belge de Radiologie, Vol. 55, No. 5, 1972, pp. 507-511.
[3]	T. Scholbach, “From the Nutcracker-Phenomenon of the Left Renal Vein to the Midline Congestion Syndrome as a Cause of Migraine, Headache, Back and Abdominal Pain and Functional Disorders of Pelvic Organs,” Medical Hypotheses, Vol. 68, No. 6, 2007, pp. 1318-1327. http://dx.doi.org/10.1016/ j.mehy.2006.10.040
[4]	J. T. Hobbs, “Varicose Vein Arising from the Pelvis Due to Ovarian Vein Incompetence,” International Journal of Clinical Practice, Vol. 59, No. 10, 2005, pp. 1195-1203. http://dx.doi.org/ 10.1111/j.1368-5031.2005.00631.x
[5]	A. D. Liddle and A. H. Davies, “Pelvic Congestion Syndrome: Chronic Pelvic Pain Caused by Ovarian and Internal Iliac Varices,” Phlebology, Vol. 22, No. 3, 2007, pp. 100-104. http://dx.doi.org/10. 1258/026835507780807248
[6]	A. Ganeshan, S. Upponi, L. Q. Hon, M. C. Uthappa, D. R. Warakaulle and R. Uberoi, “Chronic Pelvic Pain Due to Pelvic Congestion Syndrome: The Role of Diagnostic and Interventional Radiology,” Cardio Vascular and Interventional Radiology, Vol. 30, No. 6, 2007, pp. 1105-1111. http://dx.doi.org/ 10.1007/s00270-007-9160-0
[7]	G. Asciutto, A. Mumme, B. Marpe, O. Koster, K. C. Asciutto and B. Geier. “MR Venography in the Detection of Pelvic Venous Congestion,” European Journal of Vascular and Endovascular Surgery, Vol. 36, No. 4, 2008, pp. 491-496. http://dx.doi.org/10.1016/j.ejvs.2008.06.024
[8]	K. Sugaya, M. Miyazato, Y. Koyama, T. Hatano and Y. Ogawa, “Pelvic Congestion Syndrome Caused by Inferior Vena Cava Reflux,” International Journal of Urology, Vol. 7, No. 4, 2000, pp. 157-159. http://dx.doi.org/10.1046/j.1442-2042.2000.00157.x K. Masuda, T. Sekine, H. Toide, T. Doi and E. Toda, “Points of Diagnosis of Valve Diseases,” Japanese Journal of Medical Ultrasound Technology, Vol. 26, 2001, pp. 101-134.
[9]	C. Y. Choong, V. M. Abascal, J. Weyman, R. A. Levine, F. Gentile, J. D. Thomas and A. E. Weyman, “Prevalence of Valvular Regurgitation by Doppler Echocardiography in Patients with Structurally Normal Hearts by Two-Dimensional Echocardiography,” American Heart Journal, Vol. 117, No. 3, 1989, pp. 636-642. http://dx.doi.org/10.1016/0002-8703(89)90739-4
[10]	C. J. Lavie, K. Hebert and M. Cassidy, “Prevalence and Severity of Doppler-Detected Valvular Regurgitation and Estimation of Right-Sided Cardiac Pressure in Patients with Normal Two-Dimensional Echocardiograms,” Chest, Vol. 103, No. 1, 1993, pp. 226-231. http://dx.doi.org/10. 1378/chest.103.1.226
[11]	K. Sugaya, E. Matsumura, S. Tasaki, R. Kimura, A. Kiyuna, S. Nishijima and K. Kadekawa, “Relationship between Urological Disease and Inferior Vena Cava Reflux on Color Doppler Ultrasonography,” LUTS, Vol. 3, 2011, pp. 94-98.
[12]	G. D. Grossfeld, M. S. Litwin, J. S. Wolf Jr., H. Hricak, C. L. Shuler, D. C. Agerter and P. R. Carroll, “Evaluation of Asymptomatic Microscopic Hematuria in Adults: The American Urological Association Best Practice Policy-Part II: Patient Evaluation, Cytology, Voided Markers, Imaging, Cystoscopy, Nephrology Evaluation, and Follow-Up,” Urology, Vol. 57, No. 4, 2001, pp. 604-610. http://dx.doi.org/10.1016/S0090-4295(01)00920-7
[13]	S. Nishijima, K. Sugaya, M. Miyazato and Y. Ogawa, “Effect of Gosha-Jinki-Gan, a Blended Herbal Medicine, on Bladder Activity in Rats,” Journal of Urology, Vol. 177, No. 2, 2007, pp. 762-765. http://dx.doi.org/10.1016/j.juro.2006.09.077
[14]	K. Sugaya, O. Nishizawa, H. Noto, K. Sato, K. Sato, N. Shimoda, R. Otomo and S. Tsuchida, “Effects of Tsumura Chorei-to and Tsumura Chorei-to-Go-Shimotsu-to on Patients with Urethral Syndrome,” Hinyokika Kiyo, Vol. 38, No. 6, 1992, pp. 731-735.
[15]	K. Sugaya, S. Nishijima, M. Oda, M. Miyazato and Y. Ogawa, “Change of Blood Viscosity and Urinary Frequency by High Water Intake,” International Journal of Urology, Vol. 14, No. 5, 2007, pp. 470-472. http://dx.doi.org/10.1111/j.1442-2042.2006.01734.x