Issue 9/2026
Shaleva, R.
Clinic of Nephrology, Dialysis and Transplantation,
University Hospital “St. Marina”, Medical University – Varna
Hematuria in a young patient requires confirmation of erythrocyturia, assessment for urgency, and anatomical localization of the source. Urinary tract infection, urolithiasis, and glomerular disease are leading hypotheses, but neither a symptom pattern nor an isolated imaging finding establishes etiology on its own. A sequential primary-care approach is presented, based on urine sediment, quantitative proteinuria, kidney function, microbiological testing, and imaging selected according to clinical probability. Particular emphasis is placed on avoiding antibiotic treatment without evidence of infection, causal attribution of hematuria to an incidental nonobstructive calculus, and kidney biopsy without a compelling glomerular profile. Two clinical illustrations demonstrate the place of left renal vein compression in the extended differential diagnosis. Imaging evidence of compression is not synonymous with nutcracker syndrome; its clinical significance requires concordance with symptoms, urinary findings, and the assessment of alternative etiologies.
Key words: hematuria; differential diagnosis; nutcracker syndrome; IgA nephropathy; urolithiasis
Address for correspondence:
Dr. Rumina Shaleva, MD
Clinic of Nephrology, Dialysis and Transplantation,
St. Marina, University Hospital – Varna
1, “Hristo Smirnenski”, Blvd.
9010 Varna
e-mail: rumina.koleva@mu-varna.bg