Prevalence and associations of symptomatic renal papillary necrosis in sickle cell anemia patients in South-Eastern Nigeria.

AIM: To assess the prevalence and associations of symptomatic renal papillary necrosis (RPN) in sickle cell anemia patients. PATIENTS AND METHODS: The case notes of homozygous hemoglobin (Hb) S patients diagnosed with RPN were retrospectively assessed. Diagnosis was based on microscopic hematuria and positive ultrasound findings. Their steady state diastolic blood pressure, Hb, leukocyte count, platelet count, serum direct bilirubin, and aspartate transaminase, were obtained by automated analyzers. These were evaluated for any relationship with the occurrence of RPN. RESULTS: Two hundred and twenty patients were assessed aged 6-55 years with a median age of 24 years. The prevalence of symptomatic RPN was found to be 2.3%. RPN was positively associated with the female gender (Chi-square P value 0.001), but not with any other clinical or laboratory variable. However, other predictors of disease severity were positively associated with RPN such as age, diastolic blood pressure 0.180 (P = 0.016), serum aspartate transaminase, serum bilirubin 0.145 (0.027), Hb, and leukocyte count - 0.155 (P = 0.003). CONCLUSION: The prevalence of symptomatic RPN is low in this group of homozygous S patients and occurs more commonly in females. Improvement in care for these patients will reduce these chronic complications.

Severe anemia in an adolescent male with sickle cell trait: a case report.

BACKGROUND: Sickle cell trait is generally considered a benign condition. However, it has been associated with uncommon comorbidities such as painless gross hematuria secondary to renal papillary necrosis and renal medullary carcinoma. OBSERVATION: We present a 16-year-old African American boy with sickle cell trait and a recent history of prolonged gross hematuria due to renal papillary necrosis. The patient developed severe iron deficiency anemia and required transfusion support. CONCLUSIONS: Although renal papillary necrosis is well-described, it is uncommon in pediatrics and only rarely results in the need for transfusion.

Bilateral ureteric obstruction secondary to renal papillary necrosis.

A 2-year-old male presented to hospital with a 5-day history of vomiting and pyrexia. He was initially treated with non-steroidal medication as an anti-pyretic. Initial investigations demonstrated a raised urea and creatinine and he was treated with intravenous fluids. Within 24 h he became anuric with progressive renal insufficiency. Ultrasound scan demonstrated minimal bilateral hydronephrosis with debris in the lower pole calyces. The bladder was empty. Cystoscopy and retrograde contrast imaging revealed bilateral ureteric obstruction. Double J stents were inserted and his renal function returned to normal within 4 days. We believe the aetiology to be renal papillary necrosis and bilateral ureteric obstruction secondary to the administration of ibuprofen in association with dehydration.

Low dose, oral epsilon aminocaproic acid for renal papillary necrosis and massive hemorrhage in hemoglobin SC disease.

Renal papillary necrosis in sickling hemoglobinopathies can lead to significant complications, including hemorrhage, obstruction, and infection. Despite its frequency, there are limited therapies for protracted hemorrhage. In the past, massive hemorrhage was managed with nephrectomy. Here, we report a patient with hemoglobin SC disease and prolonged, life-threatening hemorrhage from papillary necrosis successfully treated with oral, low-dose epsilon aminocaproic acid (EACA). Although further study is warranted, this case illustrates the need to consider EACA in the conservative management of renal papillary necrosis and significant hemorrhage in sickle cell hemoglobinopathies.

Bilateral ureteral obstruction from papillary necrosis secondary to household cleaner ingestion.

We report a case of a patient who developed bilateral hydroureteronephrosis from papillary necrosis secondary to ingestion of commercial toilet bowl cleaner. Eight days after her ingestion, acute renal failure prompted a renal ultrasound that showed bilateral hydroureteronephrosis. Emergent bilateral percutaneous nephrostomy tubes were placed and subsequent ureteroscopy revealed a large amount of obstructing necrotic material consistent with papillary necrosis. Ureteroscopic removal of the material and bilateral ureteral stents improved renal function. The etiology of this patient's papillary necrosis was likely due to a combination of hypovolemia, systemic acidosis from the ingestion, and direct toxicity of the substance on the renal vasculature. This case demonstrates the importance of early recognition of renal insults and the extra intestinal manifestations of toxic household ingestions.

Hidronefrosis como cáncer papilar renal / Papillary renal carcinoma presenting as hydronephrosis

OBJETIVO: Describir un nuevo caso de carcinoma papilar incidental. Revisión de la literatura.MÉTODOS: El carcinoma papilar renal (CRP) es una variante dentro del carcinoma renal. Se clasifican en dos subtipos que tienen relación con su pronóstico. Presentamos un caso de CRP en un varón de 76 años, simulando una hidronefrosis evolucionada.RESULTADO/CONCLUSIONES: Se describen los hallazgos y el posterior resultado histológico asociado de una metástasis sincrónica en el uréter ipsilateral(AU)

OBJECTIVE: We describe a new case of incidental renal papillary carcinoma. We perform a bibliographic review.METHODS: The papillary renal cell carcinoma is a variant of renal carcinoma. They classify in two subtypes that have relation with their prognosis. We presented one case of renal papillary carcinoma in a male of 76 years, play-acting as severe hydronephrosis.RESULTS/DISCUSSION: We describe the findings and final pathological result associated with a synchronic metastasis in the ipsilateral ureter(AU)

An unusual cause of renal allograft dysfunction: graft papillary necrosis.

A 43-year-old nondiabetic man, 5 years post-renal transplantation, presented complaining of oliguria, fever and dysuria of 1-day duration. Graft ultrasound did not reveal any obstructive changes. Graft function did not improve in spite of 3 days of antibiotics. On the fourth day he passed fleshy material in urine subsequent to which his urine output improved and fever recovered. His graft function settled near to the previous baseline. Histological analysis of the material revealed necrosed renal papillary tissue. Renal papillary necrosis in allograft is uncommon and generally reported in the immediate postoperative phase, but it can still occur later in transplant follow-up. It is a potentially treatable cause for acute allograft dysfunction and should be suspected in transplant patients presenting with acute pyelonephritis but not getting relief from antibiotic therapy.

Acute renal papillary necrosis with complete bilateral ureteral obstruction in a child.

A 9-year-old girl presented with apparent meningococcal septicemia and developed acute renal failure after 48 hours of treatment with antibiotics and analgesics. Early ultrasound scanning demonstrated mild bilateral hydronephrosis and hydroureter. Intravenous urography showed slow contrast uptake with delay nephrogram and no contrast entering the bladder. Repeat ultrasonography revealed bilateral papillary irregularity and echogenic debris in the distal ureters. Bilateral double-J stents were inserted cystoscopically, resulting in prompt polyuria and a return of normal renal function. Although rare, recognition of sloughed papilla in papillary necrosis causing ureteral obstruction can lead to early management with no long-term sequelae.

Pielonefritis aguda en la gestación / Acute pyelonephritis in pregnancy

La pielonefritis aguda es la complicación médicagrave mas común durante la segunda mitaddel embarazo. La presencia de una bacteriuriaasintomática no diagnosticada en el primertrimestre de gestación es un factor predisponentede primer orden. Los cambios anatómicosy funcionales que el embarazo y su ambientehormonal ocasionan sobre el aparato urinariotambién facilitan el desarrollo de infeccionesurinarias y potenciales pielonefritis.Las pielonefritis agudas no complicadas de lamujer gestante están mayoritariamente ocasionadaspor enterobacterias gram negativas queascienden desde el tracto urinario inferior.Un diagnóstico certero, fundamentado en parámetrosclínicos y analíticos, junto con un eficaztratamiento antibioterápico disminuyen lascomplicaciones maternas y fetales que se ocasionanen un 20% de las pielonefritis agudasgraves

The acute pyelonephritis is the medical serious complication commonly during the second half of the pregnancy. The presence of an asymtomatic bacteriuria not diagnosed in the first trimester of gestation is a predisposition factor of the first order. The anatomical and functional changes that the pregnancy and his hormonal environment cause on the urinary device also facilitate the development of urinary infections and potential pyelonephritis. The acute pyelonephritis not complicated of the pregnancy woman are caused for the most part for negative gram enterobacterias that ascend from the lowest urinary tract. An accurate diagnosis based on clinical and analytical parameters, together with an effective antibiotic treatment they diminish the mother and foetal complications that are caused in 20% of the acute serious pyelonephritis

[Diagnosis and conservative treatment of acute pyelonephritis in diabetes mellitus].

AIM: To raise efficacy of conservative treatment of patients with acute pyelonephritis (AP) which developed in the presence of diabetes mellitus (DM). MATERIAL AND METHODS: Elderly patients (n = 218, 182 females and 36 males) with DM and AP enered the study. DM type 1 and 2 were diagnosed in 41 and 177 of them. Pyelonephritis was diffuse-purulent, pyodestructive, calculous, pyocalculous. RESULTS: Conservative treatment was made in 160 patients, surgical treatment--in 58. Lethal outcomes (14 cases) were registered as a rule in patients with bilateral pyodestructive pyelonephritis. CONCLUSION: AP is a severe complication of DM. The severity of DM decompensation and metabolic disorders is proportional to AP severity. AP in diebetics runs often an asymptomatic course and the diagnosis is difficult. Therapeutic policy is individual with consideration of a clinical course. Positive results were achieved in 80% patients.

Papillary necrosis causing hydronephrosis in renal allograft treated by percutaneous retrieval of sloughed papilla.

Obstructive uropathy is the second most common urological complication in a transplanted kidney. The usual causes of obstruction are ureteral stenosis and calculi. Papillary necrosis as a cause of obstruction in a transplant kidney is extremely rare with only one prior report published. Moreover, percutaneous removal of sloughed papilla in a transplant kidney has not previously been reported. We report an unusual case of a sloughed papilla causing hydronephrosis of a transplant kidney and its successful percutaneous removal. The recognition of renal papillary necrosis is important, not only because it can be a sign of acute rejection but also it because it can lead to obstruction, infection and potentially the loss of the transplant as exemplified by our case. Rapid diagnosis and meticulous retrieval technique are the crucial factors in minimizing the complications due to obstruction of a transplanted kidney by sloughed papilla.

Sonographic features of necrosed renal papillae causing hydronephrosis.

OBJECTIVE: To describe the sonographic appearance of ureteric obstruction due to necrosed papillae. METHODS: In this study, carried out over 3 years 6 months, patients with diabetes mellitus who had renal colic were studied by sonography. RESULTS: In 15 patients with hydronephrosis, there was a soft tissue mass of necrosed papillae filling the ureteric lumen at the site of obstruction. Necrosed papillae were seen in medullary cavities of the ipsilateral kidney in 5 patients. Ureteroscopic removal of necrosed papillae was done in 13 patients. One patient was not fit for an invasive procedure. CONCLUSIONS: When patients predisposed to renal papillary necrosis have renal colic, and sonography fails to show a ureteric calculus, it is best to look for necrosed papillae in the ureter, which may be causing obstruction.

Pregnancy in a spinal cord-injured bilateral total leg amputee: management and considerations.

A 35-year-old woman, gravida 2, para 0, was seen at 20 weeks' gestation with complete T10 spinal cord transection at age 15 years, subsequent bilateral total leg amputation, urinary diversion, colostomy, and lumbar spine resection. Pregnancy complications included recurrent urinary tract infections, preterm contractions without cervical change, lumbosacral abscesses, and fetal malpresentation. Delivery was through cesarean section near term.