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]
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]
Entire Body System
- Sepsis
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 patients with severe disease who are febrile and have smoldering sepsis, percutaneous nephrostomy is preferred because it does not require general anesthesia and carries a smaller risk of pyelovenous reflux and worsening sepsis. [medigoo.com]
Vesicoureteral reflux due to atonic bladder was presumed responsible for her rapidly progressive course to sepsis and DIC. [ci.nii.ac.jp]
/or abdominal pain Hematuria Acute ureteral obstruction from sloughed papillae manifests as flank 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]
[…] loss of H2O, NaCl, K 3. recovery (17th day): regeneration of tubules, can conx urine, risk of hypokalemia but BUN/Creatinine normalize oxalate crystals in urine etylene glycol can cause Tubular Necrosis Tx: Fomepizole hypovolemia, hypotension, shock, sepsis [quizlet.com]
- Recurrent Infection
One of them was diabetic and hypertensive female with recurrent Urinary tract Infections and other was a male with no known co-morbidity. [ncbi.nlm.nih.gov]
Hematological
- Hemophilia A
[…] another predisposing factor present Any condition associated with ischemia predisposes a person to papillary necrosis, such as Shock Dehydration Hypovolemia Sickle cell disease Tuberculosis Trauma Cirrhosis = alcoholism Coagulopathy Renal vein thrombosis Hemophilia [learningradiology.com]
Gastrointestinal
- Abdominal Pain
No history of usage of herbal remedies, diabetes mellitus, sore throat, abdominal pains, skin rashes or joint pains. Physical examination did not show any characteristic habitus or findings. [ncbi.nlm.nih.gov]
pain Hematuria Acute ureteral obstruction from sloughed papillae manifests as flank 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]
A 60-year-old man was admitted to the emergency department with acute left abdominal pain and high fever. His medical history included hypertension and gout for 13 years ago. [synapse.koreamed.org]
- 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]
- Lower Abdominal Pain
[…] and lower abdominal pain. [ncbi.nlm.nih.gov]
Cardiovascular
- Thrombosis
A: analgesic abuse (phenacetin, NSAIDs, acetaminophen: especially in combination) D: diabetes mellitus S: sickle cell disease P: pyelonephritis (especially in children) O: obstruction R: renal vein thrombosis T: renal tuberculosis (not usually confined [radiopaedia.org]
Histologically, the kidneys exhibited coagulation necrosis of the renal medulla and renal papilla, thrombosis of renal blood vessels, and interstitial medullary edema. [ncbi.nlm.nih.gov]
A mnemonic for the causes of renal papillary necrosis is POSTCARDS: pyelonephritis, obstruction of the urogenital tract, sickle cell disease, tuberculosis, cirrhosis of the liver, analgesia/alcohol abuse, renal vein thrombosis, diabetes mellitus, and [en.wikipedia.org]
Urogenital
- Hematuria
Sickle cell disease should be considered in patients with unexplained hematuria. A 26-year-old healthy Greek woman was evaluated because of new-onset painless hematuria. The physical examination was unremarkable. [nejm.org]
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]
The management of the primary clinical manifestations of this disorder, hematuria and papillary necrosis, are discussed. [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]
[…] dilated renal pelvis at the level of the proximal ureter Congenital ureterovesical junction obstruction Asymptomatic or intermittent flank pain Ultrasonography Hydronephrosis, megaureter Renal cell carcinoma Triad of flank pain, gross hematuria, and [aafp.org]
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]
Drugs with low urine solubility precipitate within the renal tubules → tubular obstruction & toxicity to tubules Symptoms Painless hematuria Flank pain Sterile pyuria Peripheral eosinophilia Rash Fever Arthralgias Patients are usually asymptomatic Renal [amboss.com]
- Oliguria
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]
As a rule oliguria was rare and progressive uremia was uncommon. [ncbi.nlm.nih.gov]
[…] atherosclerosis, dissection etc Loss of autoregulation - ACEi (dec renal blood flow), NSAIDs Hepatorenal syndrome Also bile cast nephropathy - toxic to PCT Post-renal Back pressure due to obstructed outflow Decrease GFR Lose pressure gradient Azotaemia Oliguria [alancam.com]
[…] geographic scarring), blunted calyx micro: tubules with eosinophilic casts resembling thyroid tissue + hyaline casts in tubules mercury, ethylene glycol, ABX (sulfa, neomycin, polymixin) TOXIC ACUTE TUBULAR NECROSIS tubular cells sough into PCT 3 phases: 1. oliguria [quizlet.com]
[…] interstitium of the kidney surrounding the tubules.Allergic reaction to the drugs is the most common cause.Pencillins,sulfonamides,NSAID'S,and diuretics are the usual culprits.Infections and immunologic diseases are the other causes.S/S are acute onset of oliguria [prep4usmle.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 presentation. In Acute RPN, kidneys appear enlarged and in chronic type, patchy papillary or calyceal changes are seen in early stages and all papillae are affected to some extent in later stages. [ncbi.nlm.nih.gov]
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]
- Urinary Hesitancy
hesitancy) Urinary incontinence Urinating huge quantities Urinating typically at night Examinations and Tests The area over the affected kidney (in the flank) may feel tender during an exam. [iytmed.com]
hesitancy Increased urinary frequency or urgency Polyuria (large urine volumes) Nocturia (urinating frequently at night) Incontinence Chills Signs and tests An examination may reveal tenderness on palpation over the affected kidney. [medical-dictionary-search-engines.com]
painful urination, large amounts of urine (since there is no concentration), urinary hesitancy (slow to start peeing). If you are having any of the above symptoms, please mention it to your doctor. [sicklecellwarriors.com]
hesitancy ) Urinary incontinence Urinating large amounts Urinating often at night Exams and Tests The area over the affected kidney (in the flank) may feel tender during an exam. [leehealth.org]
Increased urinary frequency or urgency. Painful urination. Passing large amounts of urine. Urinating frequently at night. Urinary hesitancy. Fever and chills. [medigoo.com]
Workup
^ "Papillary Necrosis Workup: Laboratory Studies, Imaging Studies, Diagnostic Procedures". emedicine.medscape.com. Retrieved 2015-10-15. ^ Schrier, Robert W. (2007-01-01). Diseases of the Kidney and Urinary Tract. [en.wikipedia.org]
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]
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]
X-Ray
- 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]
Treatment
The case illustrates a potential hazard of this combination in the acute treatment of migraine. [ncbi.nlm.nih.gov]
[edit] Treatment of renal papillary necrosis is supportive, any obstruction (urethral) can be dealt with via stenting. [en.wikipedia.org]
The second edition concludes with current and developing approaches to treatment, incorporating new agents for iron chelation, methods to induce fetal hemoglobin production, novel treatment approaches, stem cell transplantation, and progress in gene therapy [books.google.com]
Renal Papillary Necrosis: Symptoms The symptoms of renal papillary necrosis include: Fever Chills Pain in the lower back or flank area Blood in the urine Tissue chunks in the urine Pain during urination Renal Papillary Necrosis: Treatment The treatment [study.com]
Tests that may be done include: Urine test Blood tests Ultrasound, CT, or other imaging tests of the kidneys Treatment There is no specific treatment for renal papillary necrosis. Treatment depends on the cause. [leehealth.org]
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]
The application of this imaging modality may translate into significant short-term improvements in the evolution and prognosis of these patients. [repositorio.uchile.cl]
Acute interstitial nephritis generally has a good prognosis. [amboss.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 by itself. [iytmed.com]
Etiology
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]
Epidemiology
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]
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]
Pathophysiology
· 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]
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]
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]
Prevention
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]
As a means of preventing this disease greater control over analgescis is needed. [ncbi.nlm.nih.gov]
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 Analgesic toxicity can be prevented by limiting the availability of OTC analgesia. Particular attention should be given to monitoring the elderly. They are both more likely to need analgesia and more likely to use it. [patient.info]