Ghali Fady, Pattison Erik, Pais Vernon M
Clin Nephrol. 2015 Oct;84(4):251-3. doi: 10.5414/CN108581.
A 60-year-old female with an extensive history of stone disease and shock wave lithotripsy presents with recurrent and increasingly severe renal colic. Work-up reveals obstruction with translucent debris that is found to be composed of keratin. Her history of chronic irritation of the collecting system has resulted in keratinizing squamous metaplasia (KSM) with hyperkeratosis that has sloughed from the upper urinary tract and has become lodged in the ureter. Because of the worsening of her symptoms on conservative management, the patient elected for a nephrectomy and her symptoms have since resolved. KSM of the renal pelvis is a relatively rare phenomenon and most often presents with irritative symptoms. It is thought to result from chronic irritation of the urothelium. KSM has been found to be coincident with squamous cell cancers of the urinary tract, though clear data implicating KSM as a premalignant lesion is lacking. We present a case of recurrent renal colic secondary to sloughing keratin debris from KSM.
一名有广泛结石病史且接受过冲击波碎石术的60岁女性，出现反复且日益严重的肾绞痛。检查发现梗阻伴有半透明碎片，经检测其成分为角蛋白。她长期以来集合系统受到刺激，导致了伴有角化过度的角化性鳞状化生（KSM），这些物质从上部尿路脱落并嵌顿在输尿管中。由于保守治疗后症状恶化，患者选择了肾切除术，术后症状随即缓解。肾盂的KSM是一种相对罕见的现象，最常表现为刺激性症状。它被认为是由尿路上皮的慢性刺激引起的。虽然缺乏明确数据表明KSM是癌前病变，但已发现KSM与尿路鳞状细胞癌同时出现。我们报告一例因KSM脱落角蛋白碎片继发反复肾绞痛的病例。
