Detection of Medullary and Papillary Necrosis at an Early Stage by Multiphasic Helical Computerized Tomography

Abstract

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Jul 2003Detection of Medullary and Papillary Necrosis at an Early Stage by Multiphasic Helical Computerized Tomography E.K. LANG, R.J. MACCHIA, R. THOMAS, R. DAVIS, G. RUIZ-DEYA, R.A. WATSON, F. RICHTER, and B. GAYLE E.K. LANGE.K. LANG More articles by this author , R.J. MACCHIAR.J. MACCHIA More articles by this author , R. THOMASR. THOMAS Financial interest and/or other relationship with Boehringer Ingelheim, Ethicon and Microvasive. More articles by this author , R. DAVISR. DAVIS More articles by this author , G. RUIZ-DEYAG. RUIZ-DEYA More articles by this author , R.A. WATSONR.A. WATSON More articles by this author , F. RICHTERF. RICHTER More articles by this author , and B. GAYLEB. GAYLE More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000069684.29894.29AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Multiphasic helical computerized tomography (CT) is advocated to identify early manifestations of papillary and medullary necrosis based on decreased enhancement of circumscribed areas in the medullary pyramid. At this stage the devascularizing process can be reversed if causative conditions such as infections or diabetes mellitus are effectively treated. Materials and Methods: Multiphasic helical CTs were performed in 31 male and 26 female patients with complaints of microscopic hematuria (41), macroscopic hematuria (2), bacteriuria (39) and pyuria (9). Pre-enhancement, arterial, early corticomedullary, parenchymal and excretory phase helical CTs generated 1.25 to 5 mm. thick slices. Followup examination included multiphasic helical CT at 1 and 3 months, and excretory urography for some patients at 3 months. Results: Bacteriuria was identified as the probable cause of medullary and papillary necrosis in 39 patients, of whom 28 were treated with effective antibiotic therapy, resulting in normalization and re-perfusion of the initial lesion in 16, no change in 5 and progressive disease in 7 at 3-month followup. Of 8 lesions not treated with specific antibiotic therapy 4 progressed and 4 remained unchanged. Conclusions: Multiphasic helical CT unlike the excretory urogram can identify medullary and papillary necrosis at an early stage when effective treatment of the underlying cause can reverse the process of devascularization and prevent sloughing of medullary tissues. References 1 : Ueber Necrose der Nierenpapillen bei Hydronephrose. Arch Path Anat1877; 69: 308. Google Scholar 2 : Renal papillary necrosis: a clinical pathologic study of 42 cases. J Urol1957; 77: 557. Abstract, Google Scholar 3 : Renal papillary necrosis in sickle cell hemoglobinopathies. J Urol1996; 115: 497. Google Scholar 4 : Pathophysiology of drug-induced papillary necrosis. Fundam Appl Toxicol1984; 4: 909. Google Scholar 5 : Candida-associated renal papillary necrosis. Am J Clin Pathol1981; 75: 190. Google Scholar 6 : Renal papillary necrosis—a sixteen-year clinical experience. J Am Soc Nephrol1995; 6: 248. Google Scholar 7 : Renal papillary necrosis in a patient with sickle cell trait. J Am Soc Nephrol1997; 8: 1034. Google Scholar 8 : Molecular mechanism of red cell “sickling”. Science1966; 153: 145. Google Scholar 9 : Computed tomography and ultrasonography: a comparative study in the diagnosis of analgesic nephropathy. Nephron1994; 66: 62. Google Scholar 10 : Computerized tomography tailored for the assessment of microscopic hematuria. J Urol2002; 167: 547. Link, Google Scholar 11 : Essential Atlas of Nephrology. Philadelphia: Lippincott, Williams & Wilkins2001. Google Scholar 12 : Papillary necrosis. e Med J2001; 2: 1. Google Scholar 13 : Renal cyst pseudoenhancement: beam-hardening effects on CT numbers. Radiology1999; 213: 468. Google Scholar 14 : Renal Microvascular Disease: Angiographic-Microangiographic Correlates. Boston: Little Brown & Co1980: 333. Google Scholar From the Departments of Radiology and Urology, Tulane University Health Sciences Center, New Orleans, Louisiana, SUNY Downstate Medical School, Brooklyn, Departments of Urology, UMDNJ, New Jersey Medical School, Newark, New Jersey, and Humbold University, Charite’, Berlin, Germany© 2003 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited ByLANG E, THOMAS R, DAVIS R, MYERS L, SABEL A, MACCHIA R, GAYLE B, WATSON R, CHO T, RICHTER F, LECHNER G, MARBERGER M and HELBICH T (2018) Multiphasic Helical Computerized Tomography for the Assessment of Microscopic Hematuria:: A Prospective StudyJournal of Urology, VOL. 171, NO. 1, (237-243), Online publication date: 1-Jan-2004. Volume 170Issue 1July 2003Page: 94-98 Advertisement Copyright & Permissions© 2003 by American Urological Association, Inc.Keywordskidneyinfection, kidney papillary necrosis, tomographyMetricsAuthor Information E.K. LANG More articles by this author R.J. MACCHIA More articles by this author R. THOMAS Financial interest and/or other relationship with Boehringer Ingelheim, Ethicon and Microvasive. More articles by this author R. DAVIS More articles by this author G. RUIZ-DEYA More articles by this author R.A. WATSON More articles by this author F. RICHTER More articles by this author B. GAYLE More articles by this author Expand All Advertisement PDF DownloadLoading ...