A Rare Presentation of Renal Papillary Necrosis in a COVID-19-Positive Patient

Abstract

In this case report we describe an unusual presentation of severe acute papillary necrosis in a COVID-19-positive patient. An emergency flexible ureteroscopy greatly helped in the establishment of the diagnosis. In the international literature, there is a paucity of intraoperative endoscopic images representing severe renal papillary necrosis. We present a case of severe acute renal papillary necrosis in a 49-year-old south-Asian, COVID-19-positive male patient who needed emergency urological intervention for macroscopic hematuria and urinary retention due to clot formation in the urinary bladder. The patient underwent emergency cystoscopy, clot evacuation, and by rigid and flexible ureteroscopy. The diagnosis was only confirmed in the postoperative period, retrospectively. Finally, the patient fully recovered due to the multidisciplinary management. Diagnosis of rare clinical entities can be sometimes challenging in the everyday routine practice. Having atypical clinical course, the surgeon should be prepared and sometimes must take responsible decisions promptly, even if needed intraoperatively, to manage unexpected findings in order to get the right diagnosis without compromising the patient’s safety.

Renal Papillary Necrosis Associated with Multiple Risk Factors: A Case Report

“…In line with our case, Tallai et al presented a patient with RPN and a history of DM2 and COVID-19 (asymptomatic and any receive any medication) (22). They stated that COVID-19-induced viral infection may probably affect the necrotizing process in the kidneys due to unknown reasons (22).…”

“…In line with our case, Tallai et al presented a patient with RPN and a history of DM2 and COVID-19 (asymptomatic and any receive any medication) (22). They stated that COVID-19-induced viral infection may probably affect the necrotizing process in the kidneys due to unknown reasons (22). The renal papillae are sensitive to ischemic causing vascular disorder linked to diabetes, as well as interstitial edema causing infection (1).…”

Renal Papillary Necrosis (RPN) in an African Population: Disease Patterns, Relevant Pathways, and Management

“…Inflammatory features similar to those depicted in Figure 2B and the presence of fluffy tissue in almost all of the renal calyces similar to Figure 2C were observed. This case somehow validated the importance of incorporating screening for viral infections in patients suspected of RPN [71]. Therefore, the impact of new emerging infections such as COVID-19 on renal function and RPN should be considered.…”