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  Table of Contents  
LETTER TO EDITOR
Year : 2015  |  Volume : 25  |  Issue : 2  |  Page : 123-124
 

Obstructive uropathy: Is it always urolithiasis?


1 Department of Renal Transplant and Urology, Institute of Liver and Biliary Sciences, New Delhi, India
2 Department of Radiology/Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India

Date of Web Publication9-Mar-2015

Correspondence Address:
Dr. B Sureka
Department of Radiology/Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi - 110 070
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-4065.147372

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How to cite this article:
Jain V, Sureka B, Bansal K, Arora A. Obstructive uropathy: Is it always urolithiasis? . Indian J Nephrol 2015;25:123-4

How to cite this URL:
Jain V, Sureka B, Bansal K, Arora A. Obstructive uropathy: Is it always urolithiasis? . Indian J Nephrol [serial online] 2015 [cited 2020 Jan 23];25:123-4. Available from: http://www.indianjnephrol.org/text.asp?2015/25/2/123/147372


Sir,

A 54-year-old diabetic female was admitted with left lank pain and high grade fever since 4 days. Ultrasonography showed left hydronephrosis with proximal ureteric dilatation. The patient was treated with intravenous broad spectrum antibiotics and her sugar levels optimized. Urinanalysis showed field full of pus cells. The renal function tests were deranged (blood urea 84 mg/dl, serum creatinine 2.1 mg/dl). Total leukocyte counts were 18,000/mm 3 . Noncontrast computed tomography (CT) scan KUB showed a radiodense shadow at the level of L3 vertebrae in left ureter causing proximal hydroureteronephrosis [Figure 1]. The patient was posted for uretero-renoscopic lithotripsy of the calculus. However, on ureteroscopy a necrosed renal papilla was found impacted in the proximal ureter [Figure 2]a. It was removed and a Double J stent was placed. The necrosed papilla with calcification was confirmed on histopathologic examination [Figure 2]b. The total white blood cells counts reduced to normal limits on 1 st postoperative day (POD) and she was discharged on POD 2 on oral antibiotics.
Figure 1: A coronal image showing a radio dense shadow in left proximal ureter


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Figure 2: (a) An endo-urologic view of the necrosed papilla in ureter. (b) A microscopic view of papilla showing crystalline material embedded in amorphous background tissue


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Renal papillary necrosis (RPN) is a clinical condition that arises due to impairment of blood circulation to papillary tip of renal medulla due to diabetes mellitus, sickle cell disease, pyelonephritis, renal vein thrombosis, analgesic abuse, genitourinary tuberculosis and obstructive uropathy. In many situations, these clinical conditions might be found in isolation or in combination with each other. Renal allograft (cadaver donor more than live donor) after kidney transplantation is also prone to this condition [1],[2] owing to acute rejection due to fungal infections. [3],[4]

The diagnosis of RPN remains challenging. Previously, intravenous urography was commonly performed in such situation. In recent times, CT urography has proved to be much more informative in diagnosing RPN. Thinner sections, and reconstructed imaging with multidetector row CT has further taken us a step closer in documenting this condition. [5],[6] Necrosed renal papilla might get calcified prior to detachment and subsequently lead to obstructive uropathy after getting impacted anywhere in ureter. Ultrasound at this point, followed by CT KUB might easily give a false impression of a ureteric calculus causing obstruction, as presented in a given scenario.

 
  References Top

1.
Kaude JV, Stone M, Fuller TJ, Cade R, Tarrant DG, Juncos LI. Papillary necrosis in kidney transplant patients. Radiology 1976;120:69-74.  Back to cited text no. 1
    
2.
Shapeero LG, Vordermark JS. Papillary necrosis causing hydronephrosis in the renal allograft. Sonographic findings. J Ultrasound Med 1989;8:579-81.  Back to cited text no. 2
    
3.
Desport E, Bridoux F, Ayache RA, Thierry A, Belmouaz S, Irani J, et al. Papillary necrosis following segmental renal infarction: An unusual cause of early renal allograft dysfunction. Nephrol Dial Transplant 2005;20:830-3.  Back to cited text no. 3
    
4.
Hadaya K, Akposso K, Costa de Beauregard MA, Haymann JP, Rondeau E, Sraer JD. Isolated urinary aspergillosis in a renal transplant recipient. Nephrol Dial Transplant 1998;13:2382-4.  Back to cited text no. 4
    
5.
Andriole GL, Bahnson RR. Computed tomographic diagnosis of ureteral obstruction caused by a sloughed papilla. Urol Radiol 1987;9:45-6.  Back to cited text no. 5
    
6.
Joffe SA, Servaes S, Okon S, Horowitz M. Multi-detector row CT urography in the evaluation of hematuria. Radiographics 2003;23:1441-55.  Back to cited text no. 6
    


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