Acute renal papillary necrosis with complete bilateral ureteral obstruction in a child.
A 9-year-old girl presented with apparent meningococcal septicemia and developed acute renal failure after 48 hours of treatment with antibiotics and analgesics. Early ultrasound scanning demonstrated mild bilateral hydronephrosis and hydroureter. Intravenous urography showed slow contrast uptake with delay nephrogram and no contrast entering the bladder. Repeat ultrasonography revealed bilateral papillary irregularity and echogenic debris in the distal ureters. Bilateral double-J stents were inserted cystoscopically, resulting in prompt polyuria and a return of normal renal function. Although rare, recognition of sloughed papilla in papillary necrosis causing ureteral obstruction can lead to early management with no long-term sequelae.
Gordon
Morris
M
Department of Paediatric Urology, Central Manchester and Manchester Children's University Hospitals NHS Trust, Manchester, United Kingdom.
Cervellione
Raimondo M
RM
Postlethwaite
Robert
R
Shabani
Abdu
A
Hennayake
Supul
S
D000208:Acute Disease; D058186:Acute Kidney Injury / Q000209:etiology; D002648:Child; D003558:Cystoscopy; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000000981:diagnostic imaging / Q000209:etiology; D007668:Kidney / Q000000981:diagnostic imaging; D007681:Kidney Papillary Necrosis / Q000150:complications* / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D018805:Sepsis / Q000150:complications; D015607:Stents; D014463:Ultrasonography; D014517:Ureteral Obstruction / Q000209:etiology* / Q000628:therapy; D014546:Urinary Catheterization