RESUMEN
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.
Asunto(s)
Hematuria , Necrosis Papilar Renal , Femenino , Humanos , Médula Renal , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
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.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Hematuria , Necrosis Papilar Renal , Tomografía Computarizada por Rayos X , Médula RenalRESUMEN
Background: Urolithiasis is one of the important lower urinary tract diseases in dogs. Uroliths develop when urine becomessupersaturated. 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 theevaluation of histopathological changes in kidney and urinary bladder caused by urolithiasis with sitruvite, a pathologycommonly seen in dogs. Renal papillary necrosis that encountered in the case was evaluated histopathologically. We intendto 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 urolithswas determined by a series of chemical analyses in Department of Biochemistry. X-ray diffraction was performed as wellin General Directorate of Mineral Research and Exploration in the objective of result verification. Macroscopically, 30pieces uroliths with varying size from 1 mm to 3 cm were seen in urinary bladder. They were 110 g in weight with smoothsurface 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). Bladderwall thickening and hemorrhage on mucosa were noticed. Kidneys had roughened surface with the capsule being difficultto 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...(AU)
Asunto(s)
Animales , Femenino , Perros , Urolitiasis/complicaciones , Urolitiasis/veterinaria , Necrosis Papilar Renal/veterinaria , EstruvitaRESUMEN
Background: Urolithiasis is one of the important lower urinary tract diseases in dogs. Uroliths develop when urine becomessupersaturated. 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 theevaluation of histopathological changes in kidney and urinary bladder caused by urolithiasis with sitruvite, a pathologycommonly seen in dogs. Renal papillary necrosis that encountered in the case was evaluated histopathologically. We intendto 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 urolithswas determined by a series of chemical analyses in Department of Biochemistry. X-ray diffraction was performed as wellin General Directorate of Mineral Research and Exploration in the objective of result verification. Macroscopically, 30pieces uroliths with varying size from 1 mm to 3 cm were seen in urinary bladder. They were 110 g in weight with smoothsurface 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). Bladderwall thickening and hemorrhage on mucosa were noticed. Kidneys had roughened surface with the capsule being difficultto 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...
Asunto(s)
Femenino , Animales , Perros , Estruvita , Necrosis Papilar Renal/veterinaria , Urolitiasis/complicaciones , Urolitiasis/veterinariaRESUMEN
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)
Asunto(s)
Humanos , Necrosis Papilar Renal , Pronóstico , HistologíaAsunto(s)
Humanos , Masculino , Adulto , Anemia de Células Falciformes , Necrosis Papilar Renal , Diálisis , Insuficiencia RenalRESUMEN
BACKGROUND: Macroscopic haematuria secondary to renal cyst rupture is a frequent complication in autosomal dominant polycystic kidney disease (ADPKD). Sickle-cell disease is an autosomal recessive haemoglobinopathy that involves a qualitative anomaly of haemoglobin due to substitution of valine for the glutamic acid in the sixth position of 3-globin gene on the short arm of chromosome 11. For the full disease to be manifested, this mutation must be present on both inherited alleles. The severity of the disease is proportional to the quantity of haemoglobin S (Hb S) in the red cells; sickle-cell trait (Hb S <50%) and homozygous sickle-cell disease (Hb S >75%). In sickle-cell disease, the abnormal Hb S loses its rheological characteristics and is responsible of the various systemic manifestations including those of the kidney, such as macroscopic haematuria secondary to papilar necrosis. Despite the generally benign nature of the sickle-cell trait, several potentially serious complications have been described. Metabolic or environmental changes such as hypoxia, acidosis, dehydration, hyperosmolality or hyperthermia may transform silent sickle-cell trait into a syndrome resembling sickle-cell disease with vaso-occlusive crisis due to an accumulation of low deformable red blood cells in the microcirculation originating haematuria from papilar necrosis. On the other hand, it has been demonstrated an earlier onset of end-stage renal disease (ESRD), in blacks with ADPKD and sickle-cell trait when compared with blacks with ADPKD without the trait. PATIENTS AND METHODS: We studied 2 african-american families (4 patients) which presented with both ADPKD and sickle-cell trait (Hb S <50%). The diagnosis of sickle-cell trait was confirmed by haemoglobin electrophoresis. The renal volume was measured by magnetic resonance imaging (MRI). RESULTS: The proband subject in family 1 presented frequent haematuria episodes, associated to increase of renal volume, developed very early ESRD and was dialyzed at the age of 39 years. The other 3 patients in family 2 presented different degree of renal function. CONCLUSIONS: The presence of sickle haemoglobin should be determined in african-american and west-african patients with ADPKD because it is an important prognostic factor. Coherence of sickle-cell trait may have influence on ADPKD evolution to ESRD and other complications, such as cystic haemorrhages. MRI can identify intracystic haemorrhage and permit renal volume measure.
Asunto(s)
Riñón Poliquístico Autosómico Dominante/complicaciones , Rasgo Drepanocítico/complicaciones , Adulto , Anciano , Población Negra/genética , Niño , Progresión de la Enfermedad , República Dominicana/etnología , Femenino , Hematuria/etiología , Hematuria/cirugía , Humanos , Fallo Renal Crónico/etiología , Fallo Renal Crónico/terapia , Necrosis Papilar Renal/etiología , Masculino , Persona de Mediana Edad , Nefrectomía , Riñón Poliquístico Autosómico Dominante/epidemiología , Riñón Poliquístico Autosómico Dominante/genética , Riñón Poliquístico Autosómico Dominante/cirugía , Diálisis Renal , Rasgo Drepanocítico/etnología , Rasgo Drepanocítico/genética , España , Trombofilia/etiologíaRESUMEN
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.
Asunto(s)
Humanos , Necrosis Papilar Renal , Diagnóstico Diferencial , Necrosis Papilar Renal/fisiopatología , Necrosis Papilar Renal/patología , Nefrocalcinosis , Pielonefritis , Pronóstico , Tomografía Computarizada por Rayos X/métodos , Tuberculosis Renal , Urografía/métodosRESUMEN
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.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Inhibidores de la Proteasa del VIH/efectos adversos , Indinavir/efectos adversos , Necrosis Papilar Renal/inducido químicamente , Necrosis Papilar Renal/diagnóstico , Tuberculosis Urogenital/diagnóstico , Diagnóstico Diferencial , Tasa de Filtración Glomerular , Humanos , Masculino , Persona de Mediana EdadRESUMEN
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.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Inhibidores de la Proteasa del VIH/efectos adversos , Indinavir/efectos adversos , Necrosis Papilar Renal/inducido químicamente , Necrosis Papilar Renal/diagnóstico , Tuberculosis Urogenital/diagnóstico , Diagnóstico Diferencial , Tasa de Filtración GlomerularRESUMEN
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.
Asunto(s)
Humanos , Femenino , Anciano , Lesión Renal Aguda , Necrosis Papilar Renal/diagnóstico , Necrosis Papilar Renal/terapia , Diabetes Mellitus , Infecciones Urinarias/complicaciones , Factores de Riesgo , Choque Séptico/terapiaRESUMEN
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.
Asunto(s)
Humanos , Adolescente , Adulto , Femenino , Persona de Mediana Edad , Gentamicinas/farmacología , Necrosis Papilar Renal/tratamiento farmacológico , Antibacterianos/farmacología , Protocolos Clínicos , Infusiones Parenterales , Necrosis Papilar Renal , Necrosis Papilar Renal/orina , Nitrofurantoína/farmacología , Estudios Prospectivos , Profilaxis AntibióticaAsunto(s)
Humanos , Femenino , Embarazo , Antiinfecciosos Urinarios , Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Antibacterianos/uso terapéutico , Bacteriuria , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Cistitis , Infecciones Urinarias/etiología , Infecciones Urinarias/patología , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/terapia , Necrosis Papilar Renal , Atención Prenatal , Pielonefritis , Aminoglicósidos/efectos adversos , Chlamydia trachomatis , Cloranfenicol , Edad Gestacional , Tetraciclinas , TrimetoprimRESUMEN
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.
Asunto(s)
Radiografía , Urografía , Necrosis Papilar Renal/diagnóstico , Necrosis Papilar Renal/etiología , Necrosis Papilar RenalRESUMEN
BACKGROUND: The effect of bromoethylamine (BEA) administration on lipid peroxidation and on the activities 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 in cortex. CONCLUSION: These data suggest some role of oxidative stress in the mechanism of BEA-induced papillary necrosis.