{"id":6189,"date":"2026-02-12T14:55:00","date_gmt":"2026-02-12T12:55:00","guid":{"rendered":"https:\/\/rijetke-bolesti.com\/?p=6189"},"modified":"2026-03-14T21:35:16","modified_gmt":"2026-03-14T19:35:16","slug":"nutcracker-sindrom","status":"publish","type":"post","link":"https:\/\/rijetke-bolesti.com\/en\/nutcracker-sindrom\/","title":{"rendered":"Nutcracker sindrom"},"content":{"rendered":"<p>Nutcracker sindrom (sindrom ora\u0161ara) rijetko je i \u010desto nedovoljno prepoznato vaskularno stanje ukojemu dolazi do kompresije lijeve bubre\u017ene vene izme\u0111u aorte i gornje mezenteri\u010dne arterije poputoraha stisnuta izme\u0111u dva tvrda tijela, odakle i potje\u010de njegovo ime. Ova kompresija uzrokuje povi\u0161entlak u lijevoj bubre\u017enoj veni i niz simptoma koji mogu ozbiljno naru\u0161iti kvalitetu \u017eivota oboljelih, a kojise zbog svoje nespecifi\u010dnosti \u010desto pripisuju drugim bolestima.<\/p>\n\n\n\n<p>Postoje dva osnovna oblika: prednji nutcracker sindrom, koji je daleko \u010de\u0161\u0107i i u kojemu je lijevububre\u017enu venu komprimiraju aorta i gornja mezenteri\u010dna arterija, te stra\u017enji nutcracker sindrom, gdjeje retroaortalna bubre\u017ena vena komprimirana izme\u0111u aorte i kralje\u017enice. Sindrom mo\u017ee zahvatiti ljudesvih dobi, ali naj\u010de\u0161\u0107e se javlja u mla\u0111ih odraslih osoba i adolescenata, posebno onih vitke gra\u0111e. <\/p>\n\n\n\n<p>Simptomi nutcracker sindroma su raznoliki i mogu varirati od blage nelagode do izrazito iscrpljuju\u0107ih tegoba. <\/p>\n\n\n\n<p>Naj\u010de\u0161\u0107e se javljaju:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>hematurija (krv u mokra\u0107i)\u2013makroskopska ili mikroskopska<\/li>\n\n\n\n<li>kroni\u010dna bol u lijevom boku ili donjem dijelu le\u0111a<\/li>\n\n\n\n<li>bol u zdjelici, osobito u \u017eena (pelvi\u010dna kongestija)<\/li>\n\n\n\n<li>varikokela (pro\u0161irene vene testisa) u mu\u0161karaca<\/li>\n\n\n\n<li>proteinurija (bjelan\u010devine u mokra\u0107i)\uf0b7umor i anemija uzrokovana kroni\u010dnim gubitkom krvi<\/li>\n\n\n\n<li>ortostatska hipotenzija i nesvjestica u nekih bolesnika<\/li>\n<\/ul>\n\n\n\n<p>Nutcracker sindrom jedan je od najte\u017eih dijagnosti\u010dkih izazova u medicini jer njegovi simptomi nalikujustanjima poput urinarne infekcije, bubre\u017enih kamenaca, endometrioze ili glomerulonefropatija.Pacijenti, osobito \u017eene s pelvin\u010dnom boli,godinama mogu biti lije\u010deni od pogre\u0161nih dijagnoza.Standardne pretrage poput ultrazvuka ponekad ne otkrivaju kompresiju, a dijagnoza se potvr\u0111ujeDoppler ultrazvukom, CT ili MR angiografijom te, u nejasnim slu\u010dajevima, mjerenjem tlaka u bubre\u017enojveni.<\/p>\n\n\n\n<p>To\u010dan uzrok nastanka nutcracker sindroma vezan je uz anatomsku varijantnost polo\u017eaja krvnih \u017eila imalog kuta izme\u0111u aorte i gornje mezenteri\u010dne arterije (normalno iznosi 45-60\u00b0, a kod ovog sindroma \u010desto je ispod 20\u00b0). Nizak indeks tjelesne mase i nedostatak perivaskularne masno\u0107e, koja ina\u010de \u0161titivenu od kompresije, dodatno pove\u0107avaju rizik. U dijela bolesnika sindrom se spontano pobolj\u0161ava s rastom i prirastom tjelesne mase, \u0161to je posebno vidljivo u adolescenata.<\/p>\n\n\n\n<p>Lije\u010denje nutcracker sindroma prilago\u0111ava se dobi bolesnika, intenzitetu simptoma i stupnjuvaskularnih promjena. U bla\u017eim slu\u010dajevima i kod djece i adolescenata preporu\u010duje se konzervativnopra\u0107enje uz mogu\u0107e spontano pobolj\u0161anje. U simptomatskih bolesnika kod kojih konzervativni pristupnije dovoljan, dolaze u obzir endovaskularni zahvati, odnosno postavljanje stenta u lijevu bubre\u017enuvenu, ili kirur\u0161ka rje\u0161enja poput transpozicije bubre\u017ene vene ili mezenteri\u010dne vene. Svaki terapijskipristup nosi svoje rizike i prednosti, te se odluka donosi individualno u suradnji s vaskularnim kirurgomi nefrologom.<\/p>\n\n\n\n<p>Nutcracker sindrom nije samo fizi\u010dki problem. Kroni\u010dna bol, ponavljaju\u0107e epizode hematurije i dugi putdo dijagnoze emocionalno iscrpljuju bolesnike i mogu dovesti do anksioznosti i depresije. Mnogibolesnici godinama tragaju za dijagnozom, nailaze na nerazumijevanje u zdravstvenom sustavu iosje\u0107aju se neshva\u0107eno, \u0161to dodatno ote\u017eava no\u0161enje s bole\u0161\u0107u.<\/p>\n\n\n\n<p>Podizanje svjesnosti o nutcracker sindromu klju\u010dno je za skra\u0107ivanje dijagnosti\u010dkog puta ipravovremeno usmjeravanje bolesnika specijalistima koji poznaju ovo stanje. Multidisciplinaranpristup, koji uklju\u010duje nefrologe, vaskularne kirurge, radiologe i psihologe, jedini je put premau\u010dinkovitom lije\u010denju i pobolj\u0161anju kvalitete \u017eivota oboljelih.<\/p>\n\n\n\n<p>Izvori:<\/p>\n\n\n\n<p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK559189\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK559189<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/my.clevelandclinic.org\/health\/diseases\/23494-nutcracker-syndrome\">https:\/\/my.clevelandclinic.org\/health\/diseases\/23494-nutcracker-syndrome<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC8569268\">https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC8569268<\/a><\/p>\n\n\n\n<p><\/p>","protected":false},"excerpt":{"rendered":"<p>Nutcracker sindrom (sindrom ora\u0161ara) rijetko je i \u010desto nedovoljno prepoznato vaskularno stanje ukojemu dolazi do kompresije lijeve bubre\u017ene vene izme\u0111u aorte i gornje mezenteri\u010dne arterije poputoraha stisnuta izme\u0111u dva tvrda tijela, odakle i potje\u010de njegovo ime. Ova kompresija uzrokuje povi\u0161entlak u lijevoj bubre\u017enoj veni i&#8230;<\/p>","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"content-type":"","footnotes":""},"categories":[34],"tags":[],"class_list":["post-6189","post","type-post","status-publish","format-standard","hentry","category-rijetka-infoteka"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Nutcracker sindrom - Hrvatski savez za rijetke bolesti<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/rijetke-bolesti.com\/en\/nutcracker-sindrom\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Nutcracker sindrom - Hrvatski savez za rijetke bolesti\" \/>\n<meta property=\"og:description\" content=\"Nutcracker sindrom (sindrom ora\u0161ara) rijetko je i \u010desto nedovoljno prepoznato vaskularno stanje ukojemu dolazi do kompresije lijeve bubre\u017ene vene izme\u0111u aorte i gornje mezenteri\u010dne arterije poputoraha stisnuta izme\u0111u dva tvrda tijela, odakle i potje\u010de njegovo ime. 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