Candidal REnal Papillary Necrosis Treated with Bilateral Nepherectomy: Report of a Case / 대한신장학회잡지

Renal papillary necrosis(RPN) is a 4bointerstitial nephropathy accompanied by compromised medullary blood flow that ultimately results in a focal or diffuse ischemic necrosis of segments of the renal medulla. Renal papillary necrosis is infrequently reported as complication of fungal infections. Underlying condi- tions such as prematurity, immunosuppressive therapy, neoplastic disease, previous antibiotic therapy, diabetes mellitus, extensive burn and indwelling vascular catheters were found in candidal RPN. Candidal renal papillary necrosis is a extremely rare and fatal disease. Only 20 cases were reported over the past. There were only three survivors which were diagnosed were treated with antifugal agents early in the clinical course. As far as we know, this case is the first case of candidal RPN treated with bilateral nephrectomy. We report a case of candidal renal papillary necrosis in a 66-year-old diabetic woman treated with bilateral nephrectomy, along with review of the literatures.

A Case of Renal Papillary Necrosis Associated with Diabetes Mellitus / 대한비뇨기과학회지

Renal papillary necrosis is rare. It usually occurs in association with diabetes mellitus, pyelonephritis, urinary tract obstruction, analgesic abuse and sickle cell hemoglobinopathies. The basic pathophysiologic process in renal papillary necrosis appears to be ischemic necrosis. We experienced a case of renal papillary necrosis associated with diabetes mellitus. This 59 years old female was diabetic for 10 years and had persistent pyuria, not controlled with antibiotics. The excretory urography showed nonvisualized left kidney and retrograde pyelography showed multiple irregular filling defect in pelvis and ureter. The nephrectomized kidney showed typical findings of papillary necrosis, grossly and microscopically.

Renal Papillary Necrosis / 대한비뇨기과학회지

Diabetes mellitus, obstructive uropathy and urinary infection were considered to be most important in the etiology of renal papillary necrosis in the past literature. However, since 1953, Spuhler and Zollinger reported an association between phenacetin abuse and renal papillary necrosis, the most frequent cause of renal papillary necrosis has been diabetes mellitus, while analgesic abuse (contained phenacetin) has been the second most common factor in recent reports. In the more recent literature, most of the patient have had neither obstructive uropathy nor urinary infection, and it is quite possible that there two condition are of no direct etiological significance. But in this case, we can not suggest definite etiological factor except urinary infection clinically. Only one case is reported showing clinical manifestations laboratory findings, pyelographic findings and pathological changes compare with previous papers.