Cracking haematuria in adolescent with negative work up.

A 16-year-old girl was referred to our nephrology clinic with persistent visible haematuria (2 months), no urinary tract infection, proteinuria ranging from negligible to 1.5 g/l, normal kidney function and otherwise negative work up including immunology screen. After negative ultrasound scans of the kidneys and bladder, normal renal biopsy and normal cystoscopy, a CT angiogram was obtained. It showed no evidence of arteriovenous malformation but revealed compression of left renal vein (nutcracker syndrome).