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Renal Papillary Necrosis

Necrosis Kidney Papillary


Presentation

  • First presentation of HbSC disease after the second decade is considered late in this environment. A 25 year-old Nigerian female patient is hereby presented with renal papillary necrosis as first presentation of HbSC disease.[ncbi.nlm.nih.gov]
  • Most of the patients (67%) presented with chills and fever. Flank pain and dysuria were present in 11 patients (41%). As a rule oliguria was rare and progressive uremia was uncommon.[ncbi.nlm.nih.gov]
  • In the present study, 20 of these patients were reinvestigated up to 10 years after the original radiological studies; a total number of 46 past and present intravenous urograms were examined.[ncbi.nlm.nih.gov]
  • This study aims to remind clinicians of this "forgotten" diagnosis and what signs to look for in pediatric patients with sickle cell disease who present with hematuria.[ncbi.nlm.nih.gov]
  • A patient with sickle cell trait who presented with gross hematuria and was subsequently found to have renal papillary necrosis is presented.[ncbi.nlm.nih.gov]
Thyroid Nodule
  • Subsequent evaluation demonstrated bilateral optic neuritis and a thyroid nodule which proved to be a follicular carcinoma. Nephrologic studies revealed bilateral papillary necrosis and chronic interstitial nephritis on biopsy.[ncbi.nlm.nih.gov]
Left Flank Pain
  • A woman, aged sixty two, with the history of pyelonephritis, suddenly started to complain severe left flank pain with fever, three weeks after lumbar trauma by traffic accident.[webview.isho.jp]
  • A 58-year-old female diabetic patient complaining of left flank pain, fever and chills was admitted to our clinic. She had no past history of analgesic abuse or atypical vasculitis.[researchgate.net]
  • The patient was a 51-year-old man with poorly controlled diabetes and a history of microhematuria and an acute onset of severe left flank pain.[emedicine.medscape.com]
Myopathy
  • Another possible cause for the renal lesions in the present case could have been associated with possible capture myopathy, as this animal was captured by a good Samaritan; however, reported lesions in cases of capture myopathy include myoglobinuria,[doi.org]
Forgetful
  • .; Forget, Bernard G.; Higgs, Douglas R. (2009-08-17). Disorders of Hemoglobin: Genetics, Pathophysiology, and Clinical Management. Cambridge University Press. ISBN 9780521875196.[en.wikipedia.org]
Hematuria
  • The management of the primary clinical manifestations of this disorder, hematuria and papillary necrosis, are discussed.[ncbi.nlm.nih.gov]
  • Abstract A patient with sickle cell trait who presented with gross hematuria and was subsequently found to have renal papillary necrosis is presented.[jasn.asnjournals.org]
  • In each child hematuria was associated with more than one NSAID, and three of the five children also had ingested acetaminophen intermittently.[ncbi.nlm.nih.gov]
  • These findings are illustrated with a case of a 9-year old girl with sickle cell disease who was referred with painless gross hematuria.[ncbi.nlm.nih.gov]
  • This diagnosis should be considered in hemodialysis patients who develop hematuria.[ncbi.nlm.nih.gov]
Flank Pain
  • We describe a patient with bilateral RPN and EPN caused by Candida tropicalis, who suffered from recurrent hematuria, flank pain, acute fulminant renal failure, and obstruction by a sloughed papilla.[ncbi.nlm.nih.gov]
  • Flank pain and dysuria were present in 11 patients (41%). As a rule oliguria was rare and progressive uremia was uncommon.[ncbi.nlm.nih.gov]
  • Calyceal or ureteral obstruction by sloughed papillae manifest with flank pain, hematuria and varying degrees of renal impairment. Anuria or oliguria may be present in the fulminant stage, if renal failure develops.[radiopaedia.org]
  • ( pyelonephritis ) Kidney transplant rejection Sickle cell anemia, a typical reason for renal papillary necrosis in children Urinary tract clog Symptoms of Renal Papillary Necrosis Symptoms of renal papillary necrosis might consist of: Back pain or flank[iytmed.com]
  • pain and colic from hydronephrosis or pyonephrosis Hematuria is almost always present Clinical picture in such cases may also include fever, chills and sepsis.[learningradiology.com]
Anuria
  • Anuria or oliguria may be present in the fulminant stage, if renal failure develops. Urinary stasis leads to pyelonephritis with fever, chills or rigors.[radiopaedia.org]
  • Acute renal failure and oliguria or anuria occurs, but when it does, the disease may be fulminant, requiring dialysis and potentially resulting in death.[casereports.in]
  • Acute renal failure with oliguria or anuria is rare; when these symptoms develop, the disease may be fulminant, requiring dialysis and potentially resulting in death.[emedicine.medscape.com]

Workup

  • Signs: Patients who present with hematuria, even if diagnostic interventions indicate papillary necrosis, require a full urologic workup for their hematuria because they may have a concomitant bladder tumor or similar lesion.[medigoo.com]
  • Patients who present with hematuria, even if diagnostic interventions indicate papillary necrosis, require a full urologic workup for their hematuria because they may have a concomitant bladder tumor or similar lesion.[emedicine.medscape.com]
Nephrolithiasis
  • Nephrolithiasis and nephrocalcinosis. In: Johnson RJ, Feehally J, Floege J, eds. Comprehensive Clinical Nephrology. 5th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 59. Landry DW, Bazari H. Approach to the patient with renal disease.[nlm.nih.gov]
  • The symptomatic form manifests as an episode of pyelonephritis and hydronephrosis and it mimics nephrolithiasis. The most common presenting symptoms of symptomatic patients are fever and chills, flank and/or abdominal pain and hematuria.[casereports.in]
  • Nephrolithiasis Hypercalcaemia: nepthocalcinosis Hyperthyroid, multiple myeloma, xs VitD, mets, milk-alkali syndrome Calcium stones Can't conc ATN with acidosis, salt wasting Acute phosphate nephropathy Calcium phosphate Dialysis may be required Fistulae[alancam.com]
Candida
  • Renal papillary necrosis due to Candida albicans is a rare but treatable cause of acute renal failure.[ncbi.nlm.nih.gov]
  • We describe a patient with bilateral RPN and EPN caused by Candida tropicalis, who suffered from recurrent hematuria, flank pain, acute fulminant renal failure, and obstruction by a sloughed papilla.[ncbi.nlm.nih.gov]
  • Abstract An autopsy series of 42 patients who had visceral candidiasis was studied to determine the incidence and clinicopathologic features of Candida-associated renal papillary necrosis.[ncbi.nlm.nih.gov]
  • Renal papillary necrosis (RPN) due to Candida is a rare disease with only 19 cases reported over the past 37 years. But the diagnosis in 17 of the 19 cases was not made until a necropsy was carried out.[ncbi.nlm.nih.gov]

Treatment

  • The case illustrates a potential hazard of this combination in the acute treatment of migraine.[ncbi.nlm.nih.gov]
  • Control of infection is important, thus antimicrobial treatment is begun, so as to avert surgery (should the infection not respond). Steinberg, Martin H.; Forget, Bernard G.; Higgs, Douglas R. (2009-08-17).[en.wikipedia.org]
  • Tests that may be done include: Urine test Blood tests Ultrasound, CT, or other imaging tests of the kidneys There is no specific treatment for renal papillary necrosis. Treatment depends on the cause.[nlm.nih.gov]
  • A child with rheumatic carditis developed acute renal failure due to renal papillary necrosis while receiving a short course of aspirin treatment.[ncbi.nlm.nih.gov]
  • 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.[ncbi.nlm.nih.gov]

Prognosis

  • Destruction of the renal papilla may result in: (1) secondary degenerative cortical changes which precede chronic renal failure or (2) a rapidly metastasizing upper urothelial carcinoma, which has a very poor prognosis.[ncbi.nlm.nih.gov]
  • Outlook (Prognosis) How well a person does, depends on what is causing the condition. If the cause can be controlled, the condition may go away by itself.[iytmed.com]
  • Expectations (prognosis) The probable outcome varies. If the underlying disorder can be controlled, a spontaneous remission is possible. The progression to renal failure is also possible.[medical-dictionary-search-engines.com]
  • Outlook (Prognosis) How well a person does, depends on what is causing the condition. If the cause can be controlled, the condition may go away on its own.[leehealth.org]

Etiology

  • Abstract The radiological changes of renal papillary necrosis are independent of its etiology. If total papillary necrosis (TPN) or partial papillary necrosis (PPN) is present, radiological findings are diagnostic.[ncbi.nlm.nih.gov]
  • Urinary tract obstruction induced by a calculus seems to be the only etiologic factor in this case, although the multifactorial nature of this lesion has been stressed.[ncbi.nlm.nih.gov]
  • The etiology of renal papillary necrosis includes diabetes, analgesic abuse or overuse, sickle cell disease, pyelonephritis, renal vein thrombosis, tuberculosis, and obstructive uropathy.[ncbi.nlm.nih.gov]
  • It is known to be associated with sickle cell hemoglobinopathies; however a wide range of etiologies are possible, and it is therefore not the first diagnosis clinicians consider in patients with sickle cell disease who present with hematuria.[ncbi.nlm.nih.gov]
  • Analgesic abuse also plays an important etiologic role and is usually seen in patients old enough to self-medicate.[njcponline.com]

Epidemiology

  • Renal stone epidemiology: a 25-year study in Rochester, Minnesota. Kidney Int 1979;16:624–631. 5. Coe FL, Parks JH, Asplin JR. The pathogenesis and treatment of kidney stones. N Engl J Med 1992;327:1141–1152. 6.[synapse.koreamed.org]
  • Epidemiology Analgesic nephropathy occurs in about 4 out of 100,000 people - mostly women aged over 30. [ 4 ] In an Australasian study, of 31,654 renal replacement therapy patients, 10.2% had analgesic nephropathy. [ 5 ] In contrast, a Swiss study found[patient.info]
  • Methods Statistics Trigonometry Medical & Nursing Anatomy Anesthesiology Audiology Bacteriology Biochemistry Bioethics Biomedical Science Cardiology Cardiovascular Childbirth Chiropractic Dentistry Dermatology Diagnostic Imaging Drugs Endocrinology Epidemiology[brainscape.com]
  • This can happen by continuing to demand and generate the best epidemiologic and medical evidence, and by always clearly communicating the magnitude of the risk of adverse effects of sickle cell trait.[hematology.org]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology of renal abnormalities associated with sickle cell trait is described. The management of the primary clinical manifestations of this disorder, hematuria and papillary necrosis, are discussed.[ncbi.nlm.nih.gov]
  • The pathophysiology of renal abnormalities associated with sickle cell trait is described. The management of the primary clinical manifestations of this disorder, hematuria and papillary necrosis, are discussed. Cited By...[jasn.asnjournals.org]
  • · Presents new chapters on pathogenesis and pathophysiology of diabetic nephropathy and genetic basis of glomerular and structural kidney disorders.. · Provides expanded coverage of the pathophysiology and management of chronic kidney disease.[books.google.com]
  • Finally, the many different theories that have been proposed to explain the pathophysiology of RPN will be examined and an hypothesis will be put forward to explain the primary pathogenesis of the lesion and its secondary consequences.[ncbi.nlm.nih.gov]

Prevention

  • As a means of preventing this disease greater control over analgescis is needed.[ncbi.nlm.nih.gov]
  • The frequency with which death due to sepsis or renal failure occurs in association with UTI in alcoholics obliges the physician to exercise caution in the prevention and treatment of UTI in these patients.[ncbi.nlm.nih.gov]
  • In sickle cell, being dehydrated could lead to a crises, so preventing this is key. Having a diet rich in anti-oxidants can help prevent and reduce the inflammation and tissue damage associated with RPN.[sicklecellwarriors.com]
  • To prevent renal papillary necrosis from analgesic nephropathy, follow your supplier’s directions when utilizing medicines, consisting of non-prescription painkiller. Do not take more than the advised dose without asking your carrier.[iytmed.com]
  • Prevention Control of diabetes or sickle cell anemia may reduce risk. Prevention of renal papillary necrosis from analgesic nephropathy includes careful moderation in the use of medications, including over-the-counter analgesics .[medical-dictionary-search-engines.com]

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