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Case of the Week 562



What is the most likely diagnosis?

  • 53 year-old with long-term analgesic use



CT Urogram

  1. Osteoblastic Metastatic Disease
  2. Renal Papillary Necrosis
  3. Nephrolithiasis
  4. Transitional Cell Carcinoma
  5. Renal Cell carcinoma

Additional Images - None

 

Additional Images

 


None


Answer:

 

2. Renal Papillary Necrosis

 

More (Click Discussion Tab)

 

 

Renal Papillary Necrosis

General Considerations

  • Necrosis of the renal medullary pyramids and papillae with many causes, all of which mediate the development of ischemia
  • Infection is frequent finding, contributing to the clinical presentation of with fever and chills in about 2/3 of patients and positive urine cultures in 70%
    • But papillary necrosis can also develop without infection being present
  • Inflammatory reaction in the interstitium of the kidney compresses and compromises the medullary vasculature and predisposes the patient to ischemia and papillary necrosis

MORE . . .

 


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