A patient with history of a solitary functioning kidney and protein C deficiency (PCD) presented with recurrent severe hydronephrosis causing acute kidney injury upon chronic kidney disease. Work-up with endoscopic evaluation revealed renal papillary necrosis (RPN) and sloughed renal papillae to be the true cause of the recurrent obstruction. Pathologic evaluation of the sloughed tissue confirmed the diagnosis of RPN. This is the first case reported in the literature illustrating the unique presentation of RPN in the setting of PCD.

Diabetic neuropathy occurs in 50% of individuals with long standing diabetes mellitus. It is the most dreadful microvascular complication of poorly controlled long standing diabetes mellitus, ending up in amputation in worst cases. It is signicantly associated with age, duration of diabetes, smoking and HbA1c. Neuropathy can cause sensory decit, neurological disorder, limb ulcers, osteomyelitis and lead to amputation. Nearly 50% of diabetic peripheral neuropathy is asymptomatic. Methods: 80 cases who were diabetic and without any symptoms of neuropathy were taken into the study and both motor and sensory nerve conduction studies were performed. Results:In this study, patterns of nerve conduction velocities show abnormal conduction patterns in 65% of individuals. Of these demyelinating axonal sensorimotor neuropathy is predominant (20%), followed by demyelinating sensorimotor (15%), axonal sensory (10%), demyelinating sensory (10%), demyelinating motor (5%), axonal sensorimotor (2.5%) and axonal motor (2.5%). Conclusions: Nerve conduction studies even in asymptomatic cases may prove to be valuable indices of progression to full blown diabetic neuropathy in due course and help initiate prophylactic measures to retard its progress