Atypical Presentation of IgA Nephropathy Mimicking Acute Pyelonephritis

Background. IgA glomerulonephritis may present with hematuria, flank pain, and fever. This clinical presentation may be easily confused with acute pyelonephritis.Case Report. We present the case of a 25-year-old female with a typical clinical presentation for acute pyelonephritis (high fever, left flank pain, left costovertebral angle tenderness, hematuria, elevated inflammatory markers, and a hypoenhancing region in the left kidney on contrast-enhanced computed tomography). However, urine and blood cultures were both negative, the serum creatinine was elevated, and the urinalysis revealed significant proteinuria and dysmorphic red blood cells. A kidney biopsy confirmed a diagnosis of IgA nephropathy. She was treated with a combination of lisinopril and methylprednisolone, with good response.Conclusion. Gross hematuria, especially in the absence of pyuria or bacteriuria, should raise the suspicion for underlying IgA nephropathy, even if the rest of the clinical presentation is typical for a urinary tract infection. The presence of significant proteinuria, red blood cell casts, and dysmorphic red blood cells are useful clues suggesting glomerular disease.

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Gigantic kidney tumour presenting with weight gain

International Surgery Journal ◽

10.18203/2349-2902.isj20195151 ◽

2019 ◽

Vol 6 (11) ◽

pp. 4181

Author(s):

Balaji Chandhirasekar ◽

Sushanto Neogi ◽

Manu Vats ◽

Vineet Kumar Pandey

Keyword(s):

Computed Tomography ◽

Renal Mass ◽

Left Kidney ◽

Papillary Renal Cell Carcinoma ◽

En Bloc ◽

Kidney Tumour ◽

Contrast Enhanced ◽

Enhanced Computed Tomography ◽

Open Nephrectomy ◽

Contrast Enhanced Computed Tomography

A 61 years obese gentleman presented early with gain of weight and lump in the left side of abdomen for 15 days. On contrast enhanced computed tomography (CECT) of abdomen, a giant renal mass arising from left kidney. Patient underwent open nephrectomy, surgically removed en bloc of 12.5 kg weight largest renal mass. Histopathology showed papillary renal cell carcinoma. The postoperative period was uneventful.

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Validity of diffusion-weighted magnetic resonance imaging in the evaluation of acute pyelonephritis in comparison with contrast-enhanced computed tomography

Polish Journal of Radiology ◽

10.5114/pjr.2020.93669 ◽

2020 ◽

Vol 85 (1) ◽

pp. 137-143 ◽

Cited By ~ 1

Author(s):

Sriman Rajasekaran ◽

Venkatesh K ◽

Mathew Cherian ◽

Pankaj Mehta ◽

Shankar Radhakrishnan

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Magnetic Resonance ◽

Acute Pyelonephritis ◽

Resonance Imaging ◽

Diffusion Weighted ◽

Contrast Enhanced ◽

Weighted Magnetic Resonance Imaging ◽

Enhanced Computed Tomography ◽

Contrast Enhanced Computed Tomography

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Microvascular Doppler ultrasound in children with acute pyelonephritis

Medical Ultrasonography ◽

10.11152/mu-2827 ◽

2021 ◽

Author(s):

Gayoung Choi ◽

Bo-Kyung Je ◽

Doran Hong ◽

Jaehyung Cha

Keyword(s):

Acute Pyelonephritis ◽

Doppler Ultrasonography ◽

Interobserver Agreement ◽

Colour Doppler ◽

Diagnostic Confidence ◽

Contrast Enhanced ◽

Hospitalization Period ◽

Enhanced Computed Tomography ◽

Age Range ◽

Contrast Enhanced Computed Tomography

Aims: To compare the diagnostic performance of microvascular Doppler ultrasonography (MVUS) to B-mode and con-ventional colour Doppler US (CDUS) for detecting acute pyelonephritis (APN) lesions in children. Material and methods: An IRB-approved retrospective study was performed. From July 2018 to January 2019, 41 APN lesions in 28 children (15 boys, 13 girls; age range, 1-196 months; mean age, 53 months) who underwent 99mTc‒dimercaptosuccinic acid renal scintig-raphy (DMSA) or contrast-enhanced computed tomography (CECT) and US including B-mode, CDUS, and MVUS were enrolled in this study. Three paediatric radiologists independently reviewed the B-mode, CDUS and MVUS images for the DMSA or CECT-proven APN lesions and evaluated the lesion visibility, lesion distinguishability and diagnostic confidence between the MVUS and CDUS images. Results: A total 41 of APN lesions were verified by DMSA (41 lesions) or CECT (3 lesions) during the same hospitalization period with renal US. Among 41 APN lesions, 52.8% was visible on B-mode, 85.4% on CDUS, and 94.3% on MVUS (p<0.001). Comparing the extent and margins of the lesions, MVUS had better results than CDUS in 41.5% of the lesions, CDUS had better results in 6.5% and they were equal in 52% (p<0.001). The diagnostic con-fidence of the APN lesions was higher for MVUS than CDUS in 36.6%, higher for CDUS than MVUS in 4.9%, and equal in the remaining 58.5% (p<0.05). The interobserver agreement was fair to moderate. Conclusions: MVUS showed improved detectability of hypoperfused areas in paediatric APN and provided higher diagnostic confidence.

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Advanced Renal Pelvic Carcinoma Revealed after Treatment of a Staghorn Calculus by Endoscopic Combined Intrarenal Surgery

Case Reports in Urology ◽

10.1155/2020/9703479 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Ichiro Tsuboi ◽

Yuki Maruyama ◽

Motoo Araki ◽

Nobuyoshi Ando ◽

Yasuhiro Nishiyama ◽

...

Keyword(s):

Computed Tomography ◽

Renal Pelvis ◽

Rare Condition ◽

Flank Pain ◽

Contrast Enhanced ◽

Staghorn Calculus ◽

Enhanced Computed Tomography ◽

Contrast Enhanced Computed Tomography

Renal pelvis carcinoma associated with staghorn calculus is a clinically rare condition. A 66-year-old man presented with flank pain due to an 8 cm complete staghorn calculus. We performed three lithotomies using endoscopic combined intrarenal surgery and carried out intraoperative biopsy. Histopathological examinations revealed a keratinized lesion. One month later, contrast-enhanced computed tomography showed an advanced renal pelvis carcinoma. These findings demonstrate that even an intraoperative biopsy may be insufficient to diagnose a renal pelvis carcinoma associated with a staghorn calculus. The possibility of RPCa developing when treating a long-standing staghorn calculus should therefore be kept in mind.

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Stump appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20202872 ◽

2020 ◽

Vol 7 (7) ◽

pp. 2461

Author(s):

Ketan Vagholkar

Keyword(s):

Computed Tomography ◽

Acute Appendicitis ◽

Clinical Presentation ◽

Abdominal Operation ◽

Diagnosis And Management ◽

Stump Appendicitis ◽

Contrast Enhanced ◽

The World ◽

Enhanced Computed Tomography ◽

Contrast Enhanced Computed Tomography

Appendectomy is one of the commonest abdominal operation performed all over the world. Stump appendicitis is one of the uncommon complications of appendectomy. The diagnosis of stump appendicitis is delayed due to low index of suspicion by virtue of the fact that an appendectomy has already been done. The clinical presentation exactly simulates acute appendicitis. Contrast enhanced computed tomography is diagnostic. Completion appendectomy either open or laparoscopic is the mainstay of treatment. Awareness regarding the possible aetiology, diagnosis and management is essential for avoiding delay in the diagnosis.

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Acute Focal Bacterial Nephritis: Two Cases and Review of the Literature

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358119884310 ◽

2019 ◽

Vol 6 ◽

pp. 205435811988431

Author(s):

Adnane Guella ◽

Arshee Khan ◽

Dima Jarrah

Keyword(s):

Computed Tomography ◽

Clinical Presentation ◽

Renal Scarring ◽

Lessons Learned ◽

Antibiotic Administration ◽

Contrast Enhanced ◽

Enhanced Computed Tomography ◽

Acute Focal Bacterial Nephritis ◽

Contrast Enhanced Computed Tomography ◽

Worse Prognosis

Rationale: Acute focal bacterial nephritis (AFBN) has mainly been reported in pediatrics. It may be an underdiagnosed condition in adults because it resembles acute pyelonephritis (APN) in its clinical presentation. Presenting concerns of the patients: Two young women (25 and 27 years old, respectively) presented with complaints compatible with a diagnosis of APN. However in both, fever was of high grade, persistent for several days in spite of antibiotic administration, and there was demonstrated worsening of the inflammatory biomarkers. A contrast-enhanced computed tomography (CECT) led to the diagnosis in both cases. Diagnoses: Contrast-enhanced computed tomography reveals the most sensitive and specific images of AFBN. This includes wedge-shaped lesions with decreased enhancement, which may be focal or multifocal. Interventions (including prevention and lifestyle): Antibiotic therapy for at least 3 weeks. Outcomes: Resolution of AFBN was obtained after 3 weeks of antibiotics. Lessons learned: Our 2 cases illustrate the importance of CECT imaging to confirm the diagnosis of AFBN. Interstitial bacterial inflammation may have a worse prognosis if not diagnosed early and efficiently treated. Unlike APN, the management of AFBN requires at least 3 weeks of antibiotics to prevent the development of renal scarring and renal abscess.

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