Manzo Braulio O, Tejeda Eduardo, Chew Ben H, Alarcon Pompeyo, Flores Edson, Torres J Ernesto
Hospital Regional de Alta Especialidad del Bajío, San Carlos La Roncha, León, Guanajuato, Mexico.
Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
J Endourol Case Rep. 2020 Dec 29;6(4):526-529. doi: 10.1089/cren.2020.0141. eCollection 2020.
An uncommon cause of recurrent renal colic is mucous tissue passage secondary to renal papillae necrosis. Because of its low prevalence, the correct management of recurrent obstructive uropathy produced by renal papillary necrosis (RPN) is not well defined. We present a case of recurrent renal colic associated with the expulsion of mucous tissue in a young woman's urine with a history of excessive consumption of nonsteroidal anti-inflammatory drugs (NSAIDs). The patient required multiple admissions to the emergency department because of recurrent episodes of renal colic. A retrograde pyelogram and histopathologic study of the expulsed tissue supported the diagnosis of RPN. The patient was managed with Double-J stents for 12 months, complete withdrawal of NSAIDs, and large volume intake of water. A satisfactory outcome was seen radiologically and endoscopically after treatment. The patient stopped experiencing new renal colic episodes because of the passive ureteral dilatation despite still presenting the mucous tissue expulsion in the urine. Passive ureteral dilatation with Double-J stents could possibly be an effective treatment for patients with recurrent renal colic secondary to persistent renal papillae necrosis.
复发性肾绞痛的一个不常见原因是继发于肾乳头坏死的黏液组织排出。由于其发病率低,肾乳头坏死(RPN)所致复发性梗阻性尿路病的正确治疗方法尚不明确。我们报告一例年轻女性,有过量服用非甾体抗炎药(NSAIDs)史,其复发性肾绞痛与尿液中黏液组织排出有关。该患者因复发性肾绞痛发作多次入住急诊科。逆行肾盂造影及排出组织的组织病理学研究支持RPN的诊断。患者接受双J支架治疗12个月,完全停用NSAIDs,并大量饮水。治疗后影像学和内镜检查结果令人满意。尽管患者尿液中仍有黏液组织排出,但由于输尿管被动扩张,患者未再出现新的肾绞痛发作。双J支架置入导致的输尿管被动扩张可能是治疗继发于持续性肾乳头坏死的复发性肾绞痛患者的一种有效方法。