Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2022; 10(16): 5400-5405
Published online Jun 6, 2022. doi: 10.12998/wjcc.v10.i16.5400
Renal papillary necrosis with urinary tract obstruction: A case report
Hong-Hong Pan, Yi-Jia Luo, Qing-Guo Zhu, Lie-Fu Ye
Hong-Hong Pan, Qing-Guo Zhu, Lie-Fu Ye, Department of Urology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, Fujian Province, China
Yi-Jia Luo, Department of Ultrasound, Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, Fujian Province, China
Author contributions: Ye LF and Pan HH conceived the work; Pan HH, Luo YJ and Zhu QG conducted the work and acquired the data; Ye LF conducted the revision; all authors treated and provided care for the patient; all authors reviewed the manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lie-Fu Ye, Doctor, MD, Director, Professor, Department of Urology, Shengli Clinical Medical College of Fujian Medical University, No. 134 East Street, Gulou District, Fuzhou 350001, Fujian Province, China. fjslylf@126.com
Received: September 15, 2021
Peer-review started: September 15, 2021
First decision: November 17, 2021
Revised: November 29, 2021
Accepted: April 2, 2022
Article in press: April 2, 2022
Published online: June 6, 2022
Processing time: 259 Days and 18.1 Hours
Abstract
BACKGROUND

Renal papillary necrosis (RPN) is a rare disease. It is difficult to distinguish RPN with urinary tract obstruction from upper urinary tract occupying lesions. We reported a case of RPN and made a definite diagnosis largely based upon its endoscopic characteristics.

CASE SUMMARY

A 75-year-old woman presented with right flank pain, visible hematuria and a body temperature greater than 39 ℃. Laboratory investigations revealed leukocytosis with 12.7 × 10/L white blood cells and 93.6% neutrophils. Blood creatinine was 333 umol/L. Ultrasonography showed hydronephrosis of the right kidney and a right distal ureteric lesion. After urgent placement of right ureteral double J stent and treatment with antibiotics, the patient’s symptoms and the blood abnormalities improved rapidly. Computed tomography urography showed the presence of multiple occupying lesions in the right pelvis. The endoscopic ureteroscopy revealed that renal papillary necrosis and the subsequent migration of sloughed papillae into the upper ureter and calyces. The sloughed papillae appeared like “cottons”, which were whitish, soft, and irregularly-shaped without blood supply. In addition, the necrotic and sloughed renal papillae were removed by flexible ureteroscopy to prevent further obstruction. Pathological examination found that infarcted renal papillae were associated with inflammatory exudation. Three months after discharge, follow-up computed tomography urography showed no obvious lesions in the renal pelvis.

CONCLUSION

This case revealed the endoscopic features of RPN. In addition, flexible ureteroscopy proves to be vital in diagnosis and treatment of RPN.

Keywords: Renal papillary necrosis; Endoscopic sign; Ureteroscopy; The upper urinary tract occupying lesions; Urinary infection; Case report

Core Tip: We reported a case of urogenital sepsis and urinary obstruction. Imaging examination indicated the upper urinary tract occupying lesions, which could not exclude the possibility of malignant tumor. Further flexible ureteroscopy revealed the rare disease of renal papillary necrosis. The endoscopic examination found that necrotic renal papillae sloughed and were floating as "cottons" in the renal pelvis. They were soft, friable, whitish and irregularly-shaped without blood supply as "cottons". The migration of the necrotic renal papilla to the ureter lead to urinary tract obstruction and urogenic sepsis. So far, the endoscopic sign of renal papillary necrosis has not been reported. The report revealed the imaging and endoscopic characteristics of renal papillary necrosis, which helped the clinicians to distinguish renal papillary necrosis from malignant tumor.