Necrosis papilar renal bilateral de resolución espontánea como causa de hematuria microscópica. Caso clínico / Bilateral renal papillary necrosis of spontaneous resolution as a cause of microscopic hematuria. Report of one case

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.

Clinically localized type 1 and 2 papillary renal cell carcinomas have similar survival outcomes following surgery / Los carcinomas papilares de células renales tipo 1 y 2 localizados clínicamente tienen resultados de supervivencia similares después de la cirugía

Propósito Se intentó determinar la incidencia, hallazgos patológicos, factores pronósticos y resultados clínicos para pacientes con CCR papilar clínicamente localizado. Métodos Demográfico, Se recopilaron hallazgos clínicos y patológicos en todos los pacientes con CCRP sometidos a cirugía en cuatro centros médicos académicos. El punto final primario fue la supervivencia específica del cáncer (CSS). La supervivencia sin recaída (RFS) y la supervivencia general (OS) fueron puntos finales secundarios. Kaplan- Se obtuvieron estimaciones de Meier y se usaron modelos de regresión de riesgos proporcionales de Cox para evaluar predictores de mortalidad y recaída. Resultados Identificamos 626 CCPR, de los cuales 373 (60por ciento) fueron del tipo 1 y 253 (40 por ciento) fueron del tipo 2, con tres cuartas partes de todos los tumores siendo pT1. En comparación con los pacientes con tipo 1, aquellos con tipo 2 eran mayores (edad media: 63 frente a 61; (AU)

Purpose We aimed to determine incidence, pathologic fndings, prognostic factors and clinical outcomes for patients with clinically localized papillary RCC. Methods Demographic, clinical and pathologic fndings were collected on all patients with PRCC undergoing sur-gery at four academic medical centers. The primary end-point was cancer-specifc survival (CSS). Relapse-free survival (RFS) and overall survival (OS) were secondary endpoints. Kaplan­ Meier estimates were obtained, and Cox proportional hazard regression models were used to assess predictors of mortality and relapse. Results We identifed 626 PRCC, of which 373 (60 pertcent) were type 1 and 253 (40 pertcent) were type 2, with three-quar-ters of all tumors being pT1. Compared to patients with type 1, those with type 2 were older (mean age: 63 vs 61; (AU)

Necrosis papilar renal: el diagnóstico de un clásico en la era de la tomografía multidetector / Renal papillary necrosis: the diagnosis of a classic in the era of the multislice computed tomography

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.

Indinavir-associated toxicity mimicking urinary tuberculosis in a patient with AIDS

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.

Insuficiencia renal aguda asociada a papilitis necrotizante: reporte de un caso clínico / Acute kidney failure associated to papillary necrosis: a clinical case report

La papilitis necrotizante es una complicación de diversas patologías que tienen en común el desarrollo de algún grado de isquemia renal, las más importantes son la Diabetes Mellitus, la nefropatía por antiinflamatorios no esteroidales y la infección urinaria, estando esta última condición presente en más de 2/3 de los casos. Su espectro clínico es muy amplio, desde casos asintomáticos hasta casos de insuficiencia renal aguda obstructiva y muerte, de no mediar tratamiento oportuno. Este artículo presenta un caso clínico de papilitis necrotizante, con el fin de ilustrar las características clínicas principales de esta patología, de alta mortalidad y probablemente subdiagnosticada en nuestro medio.

Bilateral renal papillary necrosis due to Candida infection in a diabetic patient presenting as anuria.

A 38 years insulin-dependent diabetic male, with nephropathy on antituberculous treatment presented with painless frank hematuria followed by anuria for a day which was associated with fever. Ultrasonogram of the abdomen showed bilateral hydroureteronephrosis. Necrotic papillae were retrieved after ureteroscopy which on histopathological examination and culture showed Candida albicans. This was successfully treated with fluconazole and ureteroscopic removal of necrotic papillae.

Tratamiento acortado de pielonefritis aguda en mujeres / Shortened treatment in female acute pyelonephritis

Stamey, a fines de los setenta, demostró que la esterilización de la orina es un hecho muy precoz en el tratamiento de toda Infección Urinaria (IU), y mi experiencia personal de más de 20 años con tratamiento de tres días en IU en pacientes con cualquier condición clínica (febril o no), con buenos resultados, nos permite proponer tratamiento acortado en PNA. No hay acuerdo sobre la duración del tratamiento de PNA, pero en general, se propone más de 7 días. Se efectúo un protocolo prospectivo de tratamiento acortado de PNA, en pacientes sin patología obstructiva. Todas las pacientes fueron tratadas con 3 días de antimicrobiano parenteral (Gentamicina i.m., 160 mg aldía) por 3 días, y 20 a 30 días de profilaxis posterior con Nitrofurantoína oral 50 mg/noche. Se efectuó examen de orina de diagnóstico, de control al tercer día, y antes de suspender la Nitrofurantoína. Ingresaron al protocolo 40 pacientes consecutivas, con diagnóstico clínico de PNA, recibidos por el Serviciode Urgencia, con temperatura sobre 38 °C, vómitos, dolor lumbar, y examen de orina previo a tratamientocon leucocituria y bacteriuria (con cultivo positivo, confirmado posteriormente), y ecotomografía renal sin dilatación.

Emphysematous pyelonephritis.

Emphysematous pyelonephritis is a rare life-threatening suppurative necrotising infection of the renal parenchyma and perirenal tissue producing abscess formation and intrarenal gas. It is almost always seen in diabetics, making it a concern of the physician. A high index of suspicion is required for diagnosis and a combined approach has significantly reduced the mortality.

Pielonefritis enfisematosa: revisión retrospectiva y análisis de la literatura / Imaging of emphysematous pyelonephritis and review of the literature

La pielonefritis enfisematosa es una infección rara, difusa, fulminante, necrosante, supurativa, con producción rápida de gas que se disemina a través de la vía sanguínea a otros órganos, complicación fatal de una pielonefritis aguda.Es casi exclusiva de pacientes diabéticos en edad avanzada o media y en ocasiones la PE se diagnostica antes que la diabetes.El diagnóstico debe establecerse radiológicamente y hoy el mejor método de imagen y el que la literatura mundial avala como la forma más otil y práctica es la tomografía computada. El objeto de este artículo es analizar los signos radiológicos más comunes con base en imágenes obtenidas en nuestro servicio.

Changes in antioxidant enzyme activities and lipid peroxidation related to bromoethylamine-induced renal cytotoxicity

Background. The effect of bromoethylamine (BEA) administration on lipid peroxidation and on the activieties of antioxidant enzymes was studied. Methods. Adult rats received BEA at 1.2 mmol/kg, a dose that produces renal papillary necrosis. Lipid peroxidation assessed by maximal rate in MDA formation, the activities of catalase, superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), and the levels of non-protein sulfhydryls (NPSH) were measured in renal cortex and papilla of control and BEA-treated animals. Results. After BEA treatment, an increment in lipid peroxidation in papilla and cortex was found after 1.5 and 24 hours of treatment. Catalase activity decreased in both regions, but earlier cortex. Conclusion. These data suggest some role of oxidative stress in the mechanism of BEAinduced papillary necrosis

Colangiografía endoscópica retrógrada / Endoscopic retrograde cholangioghraphy

This is the first report on ERCP cases in Costa Rica, based on 264 cases. 58 per cent of the studies were made on women. The most frequent reference diagnostic were papilitis (19 per cent), extrahepatic cholastasis (16.6 per cent), choledocolithiasis (8.7 per cent) and jaundice (7.2 per cent). The papilla was seen in 96 per cent of the studies and cannulated in 89 per cent of the cases. The common bile duct was dilated in 62.4 per cent of the cases (70 per cent of these cases measured between 10 and 20 mm). The pancreatic duct was seen in 40 per cent of the studies. 11 cases of caranorna af the papilla were found. The final diagnostics were chronic papilitis (50.4 per cent), chdcdoodiffiiasis (16 per cent) and noncondusive study (10 per cent).

implication of reactive oxygen metabolites in renal tissue injury: antioxidants modulate programmed cell death [Apoptosis] induced by chemical hypoxia in renal tubular epithelial cells

The aim of this study was to evaluate the role of reactive oxygen metabolites as signals or apoptosis induced by chemical hypoxia in renal tubular epithelial cells. The present study showed that there was an increased generation of intracellular reactive oxygen species in LLC-PKI cells exposed to chemical hypoxia. Oxygen free radical scavengers, superoxide dismutase [a scavenger of superoxide radical], pyruvate [H2O2 scavenger] and dimethylthiourea, salicylate and sodium benzoate [hydroxyl radical scavengers] provide significant protection against cell death [as measured by trypan blue exclusion and LDH release] and DNA damage [as measured by alkaline unwinding assay] induced by chemical hypoxic injury. In addition, similar protection against cell death and DNA damage was also offered by the use of two iron chelators deferoxamine and 1,10 phenanthroline. In conclusion, these data indicated that reactive oxygen species play a role in programmed cell death induced by chemical hypoxic injury to renal tubular epithelial cells [LLC-PKI cells]