Shahzad Varisha, McDonald Katherine, Murphy Robert, O'Meara Yvonne
Department of Nephrology, Mater Misericordiae University Hospital, Dublin, Ireland.
School of Medicine, University College Dublin, Dublin, Ireland.
Radiol Case Rep. 2024 Mar 30;19(6):2483-2486. doi: 10.1016/j.radcr.2024.02.108. eCollection 2024 Jun.
A 51-year-old woman presented to her local emergency department with acute onset right-sided flank pain and nausea. Her blood results on admission were largely unremarkable aside from leucocytosis and neutrophilia. Two days after admission, she developed the following: stage 3 AKI with oliguria, anaemia, thrombocytopenia, and acute derangement of liver function tests. A computed tomography of the kidney ureter bladder demonstrated a right-sided 4 mm obstructing vesicoureteric junction stone with associated hydronephrosis and hydroureter. She was transferred to a tertiary care centre; gram negative sepsis was confirmed with a Proteus on blood culture and laboratory findings were in keeping with DIC. She was treated with Tazobactam/Piperacillin and intravenous fluids. In addition, further imaging showed improving right-sided hydronephrosis and left renal cortical necrosis. The aetiology of this presentation was sepsis complicated by disseminated intravascular coagulation. The coagulopathy likely contributed to the unilateral renal cortical necrosis. Cortical necrosis usually affects both kidneys, and is typically a complication of sepsis, shock, or obstetrical trauma. To our knowledge, there are only 2 reported cases of unilateral renal cortical necrosis and contralateral hydronephrosis with renal colic and septic shock. Potential pathogenetic mechanisms are discussed.
一名51岁女性因突发右侧胁腹疼痛和恶心前往当地急诊科就诊。入院时她的血液检查结果除白细胞增多和中性粒细胞增多外基本无异常。入院两天后，她出现了以下情况：3期急性肾损伤伴少尿、贫血、血小板减少以及肝功能检查急性紊乱。肾脏输尿管膀胱计算机断层扫描显示右侧有一个4毫米的膀胱输尿管连接部梗阻结石，伴有肾积水和输尿管积水。她被转至一家三级护理中心；血培养发现变形杆菌，确诊为革兰氏阴性菌败血症，实验室检查结果与弥散性血管内凝血相符。她接受了他唑巴坦/哌拉西林和静脉输液治疗。此外，进一步的影像学检查显示右侧肾积水有所改善，左侧肾皮质坏死。此次发病的病因是败血症并发弥散性血管内凝血。凝血病可能导致了单侧肾皮质坏死。皮质坏死通常累及双侧肾脏，典型情况下是败血症、休克或产科创伤的并发症。据我们所知，仅有2例关于单侧肾皮质坏死伴对侧肾积水、肾绞痛和感染性休克的报道。文中讨论了潜在的发病机制。
