ABSTRACT
Renal papillary necrosis is an infrequent cause of hematuria characterized by ischemic necrosis of the renal medulla, especially the papilla. Its most common cause is analgesic abuse. Despite being oligo-symptomatic, in many cases its presence is associated with serious functional sequelae. Imaging, especially computed tomography, is essential to make the diagnosis. We report a 63-year-old female studied for an asymptomatic microscopic hematuria whose tomographic study showed a bilateral renal papillary necrosis. No etiology was found, and she evolved with a spontaneous complete remission.
Subject(s)
Humans , Female , Middle Aged , Hematuria , Kidney Papillary Necrosis , Tomography, X-Ray Computed , Kidney MedullaABSTRACT
La necrosis papilar renal es una condición originada por múltiples factores, con consecuencias variadas incluyendo dentro de ellas el desarrollo de insuficiencia renal terminal y eventualmente la muerte. Su presentación en la pielografía de eliminación demuestra múltiples patrones de excavación papilar, que están muy bien descritos en la literatura clásica. Con el advenimiento de la urografía por tomografía computada multicorte, estos hallazgos han sido refinados, agregándose también nuevos signos, que incluyen, entre otros, la detección de cambios medulares precoces que podrían implicar, en un futuro cercano, un significativo cambio en la evolución y pronóstico de estos pacientes. En esta publicación hacemos una revisión y puesta al día de los aspectos imaginológicos de la necrosis papilar renal.
Renal papillary necrosis is a multifactorial entitiy that encompasses a wide range of consecuences, including end-stage renal impairment or even death. Its appearance on intravenous pyelography pictures reveals multiple patterns of papillary excavation, fairly well defined in traditional literature. With the advent of multislice computed tomography urography these findings have been refined and new radiological signs such as detection of early renal medullary changes, among others, have been added. The application of this imaging modality may translate into significant short-term improvements in the evolution and prognosis of these patients. This paper is intended to provide both a reviewing and an updating of renal papillary necrosis imaging issues.
Subject(s)
Humans , Kidney Papillary Necrosis , Diagnosis, Differential , Kidney Papillary Necrosis/physiopathology , Kidney Papillary Necrosis/pathology , Nephrocalcinosis , Pyelonephritis , Prognosis , Tomography, X-Ray Computed/methods , Tuberculosis, Renal , Urography/methodsABSTRACT
This case reported to a patient with AIDS who presented persistent sterile leukocyturia and hematuria, lower back pain, bladder suffering symptoms, and renal papillary necrosis which were thought to be secondary to urinary tuberculosis but were demonstrated to be indinavir-associated side effects. The intention of this report is to remind medical professionals involved in the care of HIV+ patients of this possible association in order to avoid unnecessary investigation and to stress the need of careful periodical assessment of renal function and urinalysis in patients treated with indinavir.