scholarly journals A Rare Presentation of Renal Papillary Necrosis in a COVID-19-Positive Patient

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Bela Tallai ◽  
Tawiz Gul Gulistan ◽  
Maged Nasser Aa B. Alrayashi ◽  
Salah Abdulhabeb Abdulwali Al Mughalles ◽  
Hatem Mostari Kamkoum ◽  
...  

In this case report we describe an unusual presentation of severe acute papillary necrosis in a COVID-19-positive patient. An emergency flexible ureteroscopy greatly helped in the establishment of the diagnosis. In the international literature, there is a paucity of intraoperative endoscopic images representing severe renal papillary necrosis. We present a case of severe acute renal papillary necrosis in a 49-year-old south-Asian, COVID-19-positive male patient who needed emergency urological intervention for macroscopic hematuria and urinary retention due to clot formation in the urinary bladder. The patient underwent emergency cystoscopy, clot evacuation, and by rigid and flexible ureteroscopy. The diagnosis was only confirmed in the postoperative period, retrospectively. Finally, the patient fully recovered due to the multidisciplinary management. Diagnosis of rare clinical entities can be sometimes challenging in the everyday routine practice. Having atypical clinical course, the surgeon should be prepared and sometimes must take responsible decisions promptly, even if needed intraoperatively, to manage unexpected findings in order to get the right diagnosis without compromising the patient’s safety.

2019 ◽  
Vol 47 ◽  
Author(s):  
Tuncer Kutlu ◽  
Gözde Yücel-Tenekeci ◽  
Mert Pekcan ◽  
Emir Yengy Kuler ◽  
Osman Kutsal

Background: Urolithiasis is one of the important lower urinary tract diseases in dogs. Uroliths develop when urine becomes "supersaturated”. Struvite urolithiasis in dogs is formed when urine saturated with magnesium, ammonium and phosphate. Renal papillary necrosis is a form of nephropathy involving the necrosis of the renal papilla. The aim of this case is the evaluation of histopathological changes in kidney and urinary bladder caused by urolithiasis with sitruvite, a pathology commonly seen in dogs. Renal papillary necrosis that encountered in the case was evaluated histopathologically. We intend to discuss the relationship between urolithiasis and renal papillary necrosis.Case: The material of the case was a 7.5 year-old Rottweiler female dog that had been operated for the urolithiasis treatment and died after surgery. The animal sent to pathology department was necropsied and evaluated histopathologically. Also the uroliths removed during the surgery were sent for analysis postoperatively. Qualitative composition of uroliths was determined by a series of chemical analyses in Department of Biochemistry. X-ray diffraction was performed as well in General Directorate of Mineral Research and Exploration in the objective of result verification.  Macroscopically, 30 pieces uroliths with varying size from 1 mm to 3 cm were seen in urinary bladder. They were 110 g in weight with smooth surface and round and/or ovoid shapes.  After necropsy, specimens from kidney and urinary bladder were fixed in 10% neutral buffered formalin, embedded in paraffin wax, cut at 5 μm, and stained with hematoxylin and eosin (HE).  Bladder wall thickening and hemorrhage on mucosa were noticed. Kidneys had roughened surface with the capsule being difficult to peel off. Also, renal papillary necrosis, reddish in color was observed in papilla of the right kidney. Microscopically, crystal formations were observed proximal tubule lumens of kidneys. Interstitial nephritis in cortex and medulla had been noticed in both kidneys. Interstitial nephritis has been noticed in both kidneys. Hemorrhagic necrotic area demarcated by connective tissue was encountered in medulla of the right kidney. In the lamina propria of urinary bladder hemorrhage were noted. Desquamation and degeneration of lamina epithelialis and wide hemorrhage area in lamina propria were noted in urinary bladder. Results obtained from biochemical analysis were verified with x-ray diffraction method, uroliths were determined as magnesium ammonium phosphate (struvite).Discussion: Renal papillary necrosis is a form of nephropathy involving the necrosis of the renal papilla, caused by ischemia of the inner medulla of the kidney. According to the first report of renal papillary necrosis, symmetrical soft calyceal concretions and their appearances are typical lesions for diagnosis of renal papillary necrosis. The presence of crystals in the tubule lumen and the formation of struvite stone (which has the same chemical composition with calyceal concretions) established a distinct relationship between urolithiasis and renal papillary necrosis. This case showed that struvite stones can reach large volumes in urinary bladder, and caused bladder wall thickness and hemorrhages. Also, the lower urinary tract obstruction or urolithiasis should be remembered in the renal papillary necrosis together with the risk of hydronephrosis.                 


2021 ◽  
Vol 5 (1) ◽  
pp. 37-40
Author(s):  
Brian Wanner ◽  
Austin Cusick ◽  
Jyoti Kapil ◽  
Stephen D'Addario

Basal cell carcinoma (BCC) is the most common nonmelanoma skin cancer (NMSC) with the potential of local invasion and distant metastasis. Our patient presented with an enlarging four-centimeter subcutaneous nodule over the right clavicle. An incisional biopsy demonstrated the unexpected findings of a nodular and infiltrative BCC. Definitive treatment was a radical neck dissection with adjuvant radiation therapy. Negative margins were confirmed on the excision and lymph node evaluation demonstrated no lymphatic spread. Surveillance chest computed tomography revealed new bilateral pulmonary nodules and a subsequent biopsy showed metastatic BCC. A genetic panel demonstrated TP53 mutations and no mutations in SMO. The patient was started on sonidegib and after ten months of therapy his disease was stabilized on repeat imaging. This case report demonstrates a rare presentation of a TP53 mutated, metastatic BCC responsive to sonidegib.


2021 ◽  
Vol 4 (2) ◽  
pp. e36-e44
Author(s):  
Kalyanaram Kone ◽  
Parthiban Nagaraj ◽  
Naveen Thimiri Mallikarjun ◽  
Joseph Philipraj

Introduction and Objectives: Renal papillary necrosis is one of the common causes of obstructive uropa-thy in diabetic patients. During removal of necrosed renal papilla, many patients were observed to have fluffy necrotic material in the ureter, and renal pelvis, and a few among them present again with recurrent episodes of obstructive uropathy and sepsis following DJ stent removal. Our study aimed to identify thesignificance of this fluffy necrotic material and its evaluation by histopathological examination (HPE). Materials and Methods: This is a prospective observational study done in our institute by compiling data of 56 patients admitted with obstructive uropathy secondary to renal papillary necrosis who underwent a protocol-based treatment from 2016 to 2019. All these patients underwent initial DJ stenting followed by check flexible ureteroscopy or nephroscopy after 6 weeks. The white, necrotic fluffy material collected during initial DJ stenting or with subsequent flexible ureteronephroscopy was sent for HPE. All these patients were followed up for 1-3 years. Results: Out of 56 patients, 15 patients had fluffy necrotic material in the bladder on initial cystoscopy, of which 1 patient was diagnosed with aspergillosis and 1 patient with candida infection on HPE. During check flexible ureteroscopy (FU), 19 patients had minimal burden of fluffy necrotic material in renal pelvis, of which one patient was diagnosed with aspergillosis, one with candida (same patient diagnosed on cystoscopy), and one patient with both aspergillus and candida colonies on HPE. 5 patients had the significant burden of fluffy necrotic material in the renal pelvis, requiring removal via percutaneous nephroscopic access. Among these 5 patients, 2 were diagnosed with aspergillosis and 1 with candida infection on HPE. A total of 32 patients had single papilla, and 24 had multiple papillae in the pelvicalyceal system. 5 out of 7 patients with positive fungal pathology had negative fungal cultures. Compared to our historical data of 4% mortality and 22% recurrent obstructive uropathy in the 3 years preceding the adoption of this protocol, with the present protocol, no patient developed recurrent pyelonephritis during follow-up of 1–3 years after DJ stent removal following complete evacuation of necrotic material and appropriate antifungal treatment. Conclusion: This study highlights the need for check ureterorenoscopy and removal of all necrotic papillae and debris to establish a microbiological and histopathological diagnosis along with proper antifungal treatment to prevent episodes of recurrent pyelonephritis and obstructive uropathy.  


2020 ◽  
Vol 26 (1) ◽  
Author(s):  
Tiffany A. Perkins ◽  
Alberic Rogman ◽  
Murali K. Ankem

Abstract Background Emphysematous pyelonephritis (EPN) with gas in the inferior vena cava (IVC) is a rare presentation and to our knowledge, this is the first case report in the urologic literature. Case presentation A 35-Year-old obese diabetic Hispanic female presented to the emergency room with a clinical picture of septic shock. Prompt computerized tomography scan revealed EPN with gas throughout the right renal parenchyma and extending to the right renal vein, IVC, and pulmonary artery. She died before surgical intervention Conclusion This case demonstrates that patients presenting with severe EPN have a high mortality risk and providers should acknowledge that septic shock, endogenous air emboli, or a combination of both could result in cardiovascular collapse and sudden death.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hoon Choi ◽  
Joon Pyo Jeon ◽  
Jaewon Huh ◽  
Youme Kim ◽  
Wonjung Hwang

Abstract Background Pulmonary artery catheter insertion is a routine practice in high-risk patients undergoing cardiac surgery. However, pulmonary artery catheter insertion is associated with numerous complications that can be devastating to the patient. Incorrect placement is an overlooked complication with few case reports to date. Case presentation An 18-year-old male patient underwent elective mitral valve replacement due to severe mitral valve regurgitation. The patient had a history of synovial sarcoma, and Hickman catheter had been inserted in the right internal jugular vein for systemic chemotherapy. We made multiple attempts to position the pulmonary artery catheter in the correct position but failed. A chest radiography revealed that the pulmonary artery catheter was bent and pointed in the cephalad direction. Removal of the pulmonary artery catheter was successful, and the patient was discharged 10 days after the surgery without complications. Conclusions To prevent misplacement of the PAC, clinicians should be aware of multiple risk factors in difficult PAC placement, and be prepared to utilize adjunctive methods, such as TEE and fluoroscopy.


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