A Nautilus kidney
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IMAGES IN NEPHROLOGY
A Nautilus kidney Bo‑Sheng Wu1 · Yang Ho2 · Chih‑Yu Yang1,2,3,4,5 Received: 29 May 2020 / Accepted: 6 June 2020 © Japanese Society of Nephrology 2020
Abstract We report a 71-year-old woman who presented with unilateral flank pain and sepsis. A computed tomographic (CT) scan demonstrated left-sided hydronephrosis. Subsequent percutaneous nephrotomy drainage showed pus-like material, confirming the diagnosis of pyonephrosis. The ureteral stricture was caused by previous radiation injury for cervical cancer in this ESRD patient who was on chronic dialysis for years. In our case, the grade IVB hydronephrosis is a result of an extremely atrophic kidney, pyonephrosis, and ureteral stricture. The CT section of pyonephrosis in an extremely atrophic kidney resembles a sagittal section of a Nautilus shell, as the shell corresponds to the diffusely thinned renal cortex. Keywords ESRD · Pyonephrosis · Atrophic kidney
Case presentation We report a 71-year-old woman who presented with unilateral flank pain and sepsis. A computed tomographic (CT) scan demonstrated left-sided hydronephrosis (Fig. 1). Subsequent percutaneous nephrotomy drainage showed pus-like material, confirming the diagnosis of pyonephrosis. The ureteral stricture was caused by previous radiation injury for cervical cancer in this end-stage renal disease (ESRD) patient who was on chronic dialysis for years. Hydronephrosis is classified into grade I–IV according to severity, with grade IV the most severe. Grade IV is further
classified into IVA and IVB, with the former distinguished by segmental cortical thinning, while the latter manifests as diffuse cortical thinning [1]. In the clinical setting, a grade IVB hydronephrosis kidney with diffuse parenchymal thinning is a sign of poor renal function [2]. In our case, the grade IVB hydronephrosis is the result of an extremely atrophic kidney, pyonephrosis, and ureteral stricture. Her CT image resembles a sagittal section of a Nautilus shell (Fig. 2), as the shell corresponds to the diffusely thinned renal cortex. This patient recovered after antibiotic treatment and percutaneous nephrotomy drainage.
* Chih‑Yu Yang [email protected] 1
Faculty of Medicine, School of Medicine, National YangMing University, Taipei, Taiwan
2
Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih‑Pai Road, Taipei 11217, Taiwan
3
Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
4
Stem Cell Research Center, National Yang-Ming University, Taipei, Taiwan
5
Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), Hsinchu, Taiwan
13
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Clinical and Experimental Nephrology Acknowledgements This work was in part supported financially for research purposes by the "Yin Yen-Liang Development and Construction Plan" of the School of Medicine, National Yang-Ming University, Taipei, Taiwan (107F-M01-0504), the Ministry of Science and Technology, Taipei, Taiwan (MOST 108-263
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