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    An 85-year-old man with diabetes and a urinary tract infection was admitted with fever and malaise. Imaging showed enlarged kidneys but no obstruction. Blood and urine cultures grew E. coli, and he was diagnosed with acute pyelonephritis. Despite antibiotic treatment, his condition deteriorated and he died. An autopsy revealed bilateral renal papillary necrosis, which is typically caused by the combination of diabetes and urinary tract infection due to increased vulnerability of the renal papillae to ischemic changes. Physicians should consider renal papillary necrosis as a possibility in cases of acute pyelonephritis in diabetic patients with impaired renal function.

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    An 85-year-old man with diabetes and a urinary tract infection was admitted with fever and malaise. Imaging showed enlarged kidneys but no obstruction. Blood and urine cultures grew E. coli, and he was diagnosed with acute pyelonephritis. Despite antibiotic treatment, his condition deteriorated and he died. An autopsy revealed bilateral renal papillary necrosis, which is typically caused by the combination of diabetes and urinary tract infection due to increased vulnerability of the renal papillae to ischemic changes. Physicians should consider renal papillary necrosis as a possibility in cases of acute pyelonephritis in diabetic patients with impaired renal function.

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    © All Rights Reserved
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    13 views1 page

    Update RPN PDF

    Uploaded by

    Adrian Zapata
    An 85-year-old man with diabetes and a urinary tract infection was admitted with fever and malaise. Imaging showed enlarged kidneys but no obstruction. Blood and urine cultures grew E. coli, and he was diagnosed with acute pyelonephritis. Despite antibiotic treatment, his condition deteriorated and he died. An autopsy revealed bilateral renal papillary necrosis, which is typically caused by the combination of diabetes and urinary tract infection due to increased vulnerability of the renal papillae to ischemic changes. Physicians should consider renal papillary necrosis as a possibility in cases of acute pyelonephritis in diabetic patients with impaired renal function.

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    of 1

    doi: 10.2169/internalmedicine.

    0858-18
    Intern Med Advance Publication
    http://internmed.jp

    【 PICTURES IN CLINICAL MEDICINE 】

    Renal Papillary Necrosis with Diabetes and Urinary


    Tract Infection

    Yushi Kawaguchi 1, Hideki Mori 1, Yasumori Izumi 1 and Masahiro Ito 2

    Key words: renal papillary necrosis, diabetes, urinary tract infection

    (Intern Med Advance Publication)


    (DOI: 10.2169/internalmedicine.0858-18)

    However, his condition worsened and he ultimately died. A


    pathological autopsy showed bilateral renal papillary necro-
    sis. Renal papillary necrosis is typically thought to be
    caused by diabetes mellitus and urinary tract infection. The
    renal papillae are considered to be anatomically vulnerable
    to ischemic changes, like vascular disorder with diabetes or
    interstitial edema associated with infection (1). There have
    been some cases in which rapid deterioration occured (2). In
    case of acute pyelonephritis with an impaired renal function
    in patients with diabetes, physicians should consider the
    possibility of renal papillary necrosis.

    The authors state that they have no Conflict of Interest (COI).

    Picture. 
    References
    1. Jung DC, Kim SH, Jung SI, Hwang SI, Kim SH. Renal papillary
    An 85-year-old man with a 7-year history of type 2 dia- necrosis: review and comparison of findings at multi-detector row
    betes who had no obvious diabetic complications presented CT and intravenous urography. Radiographics 1827-1836, 2006.
    2. Abdulhayoglu S, Marble A. Necrotizing Renal Papillitis (Papillary
    with a fever and malaise. He had bilateral costovertebral an- Necrosis) in diabetes mellitus. Am J Med Sci 623-632, 1964.
    gle tenderness. Laboratory data showed renal dysfunction.
    Computed tomography showed bilateral renal enlargement The Internal Medicine is an Open Access article distributed under the Creative
    but no obstructive findings. Escherichia coli was detected Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To
    view the details of this license, please visit (https://creativecommons.org/licenses/
    from blood cultures and urine. We diagnosed the patient
    by-nc-nd/4.0/).
    with acute pyelonephritis and treated him with antibiotics.

    １
    Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Japan and ２ Department of Pathology, Na-
    tional Hospital Organization Nagasaki Medical Center, Japan
    Received: January 19, 2018; Accepted: April 18, 2018; Advance Publication by J-STAGE: July 6, 2018
    Correspondence to Dr. Yushi Kawaguchi, kawaguchiy@nagasaki-mc.com
    Ⓒ The Japanese Society of Internal Medicine. Intern Med Advance Publication

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