1/70. Acute renal papillary necrosis induced by ibuprofen. Several specific renal syndromes may be induced by the interaction of nonsteroidal anti-inflammatory drugs (NSAIDs) upon renal function. We report an NSAID-induced form of acute renal failure that represents a dual mechanism of impact on renal function involving direct parenchymal damage at a renal papillary level and mechanical outflow ureteric obstruction consequent to acute papillary necrosis. This form of NSAID-related acute renal failure has been reported very infrequently. We suspect the syndrome is not often recognized clinically. Clinicians and health care workers need to remind constantly the general public concerning the standard steps to be taken to ensure the proper and safe use of over-the-counter drugs. This is especially important considering the recent FDA approval of the over-the-counter sale of naproxen sodium, ketoprofen, and ibuprofen. ( info) |
2/70. Prostaglandin E1 for renal papillary necrosis in a patient with diabetes mellitus. We report a case of renal papillary necrosis with diabetes mellitus which was treated with prostaglandin E1. An intravenous infusion of 40 mg/day prostaglandin E1 was given for 14 days in an attempt to improve renal circulation. Treatment resulted in an improved creatinine clearance, renal plasma flow and renogram, and proteinuria was decreased. The administration of prostaglandin E1 produced an improvement in renal haemodynamics and can be considered as a possible therapy for renal papillary necrosis in diabetic patients. ( info) |
3/70. Papillary necrosis in renal allografts--report of 2 cases. Two patients are reported in whom early and irreversible renal allograft rejection was associated with passage of necrotic papillary material in the urine. Evidence is presented for a causal relationship between rejection and medullary necrosis. Passage of a papilla is regarded as a definite indication for graft exploration. ( info) |
4/70. Renal papillary necrosis associated with acute pancreatitis. A case of acute renal failure with renal papillary necrosis due to acute pancreatitis is described. The association of renal papillary necrosis with acute pancreatitis has not been previously recorded, and the possible mechanisms for the production of renal papillary necrosis in this entity are discussed. ( info) |
| The hiv protease inhibitor indinavir may cause nephrolithiasis and interstitial nephritis. The renal consequences of indinavir-associated nephrotoxicity are uncertain. We report a case of papillary necrosis in a patient treated with indinavir. An asymptomatic HIV-infected woman experienced right-sided renal colicky pain during treatment with indinavir. She passed a non-solid stone and continued indinavir treatment. Intravenous pyelogram performed 20 months later following an episode of left-sided colicky pain showed right-sided papillary necrosis. indinavir-associated nephrolithiasis and chronic interstitial nephritis were the only possible causes identified in this patient. physicians should be aware that indinavir nephrolithiasis may cause papillary necrosis. ( info) |
| We present a case of nephrotic syndrome complicating acute pyelonephritis in a 45-year-old man. His first attack of acute bacterial pyelonephritis had two unusual features: transient nephrotic syndrome and chronic recurrent episodes of papillary necrosis. The former, which lasted for two weeks, was characterized by edema, excretion of 7.7 g of urinary protein per 24 hours and hypoproteinemia (1.8 g per 100 ml). A percutaneous renal biopsy two weeks after the height of the nephrotic state showed normal glomeruli by light and electron microscopy and immunohistologic studies. Interstitial changes were noted. Over two years the patient has passed approximately 50 fragments, characterized as necrotic tissue containing tubular structures. He has no evidence of diabetes mellitus, urinary-tract obstruction or ureteral reflux, analgesic abuse or atypical vasculitis. He is afebrile but has recurrent bacteriuria despite antibiotics. This case demonstrates that acute pyelonephritis must be added to the list of diseases causing the nephrotic state. ( info) |
7/70. Renal papillary necrosis as first presentation of a Nigerian sickle cell patient. The clinical features of the sickle syndromes do not appear until after the sixth month of life, at which time most of the HbF has been replaced by HbS. Thrombo-embolic complications, retinopathy and renal papillary necrosis are more frequent in HbSC disease than in other sickle cell syndromes. First presentation of HbSC disease after the second decade is considered late in this environment. A 25 year-old Nigerian female patient is hereby presented with renal papillary necrosis as first presentation of HbSC disease. The patient presented with a sudden onset of total haematuria without history suggestive of urinary tract infection, trauma, instrumentation and significant analgesic consumption. No history of usage of herbal remedies, diabetes mellitus, sore throat, abdominal pains, skin rashes or joint pains. physical examination did not show any characteristic habitus or findings. Findings on intravenous urography suggested renal papillary necrosis. ( info) |
8/70. Celecoxib-related renal papillary necrosis. Selective cyclooxygenase 2 (COX-2) inhibitors are known to affect renal prostaglandins (epoprostenol and dinoprostone), which are at least in part COX-2 dependent. Consequently, adverse events including hypertension, peripheral edema, hypercalemia, hyponatremia, and acute renal failure have been reported to occur with the new COX-2-specific inhibitors. This case report posits celecoxib as a likely cause of renal papillary necrosis and alerts physicians to the possibility of this additional renal complication with COX-2-specific inhibitors. ( info) |
9/70. Pregnancy in a spinal cord-injured bilateral total leg amputee: management and considerations. A 35-year-old woman, gravida 2, para 0, was seen at 20 weeks' gestation with complete T10 spinal cord transection at age 15 years, subsequent bilateral total leg amputation, urinary diversion, colostomy, and lumbar spine resection. pregnancy complications included recurrent urinary tract infections, preterm contractions without cervical change, lumbosacral abscesses, and fetal malpresentation. Delivery was through cesarean section near term. ( info) |
| In 2,158 consecutive routine urograms, 85 patients (51 males and 34 females) were found to have typical changes of renal papillary necrosis, an incidence of 3.9% (2.8% in males, 9.4% in females). The changes were bilateral in 60 patients (71.6%) and unilateral in 25 (29.4%). 3 patients were diabetics, 4 had sickle cell anaemia and 7 had obstructive uropathy. 19 patients admitted to analgesic abuse. The remaining 52 patients were idiopathic but a combination of analgesic abuse and dehydration may have been the cause in this group. The possible reasons for the high incidence of RPN especially in females in this hot desert environment are discussed. The literature on the subject is briefly reviewed. ( info) |