Ultrasonography in the diagnosis of obstructive uropathy caused by papillary necrosis
Edward Buonocore, M.D.
Department of Hospital Radiology
Donald G. Vidt, M.D.
Department of Hypertension and Nephrology
James E. Montie, M.D.
Department of Urology
Ultrasonography has become increasingly more important in the. diagnosis of renal disorders.1, 2 Compartmental renal anatomy is clearly delineated by ultrasonography without contrast media or instrumentation.3 This is particularly desirable in patients with acute renal failure where rapid differentiation between urinary tract obstruction and end organ failure is vital to successful therapy.
Recent experience with a young diabetic woman with acute renal failure and oliguria complicated by obstruction of the left ureter from papillary necrosis prompts this report. The differentiation between end-stage diabetic nephropathy (necessitating renal dialysis) and urinary tract obstruction (requiring surgical intervention) was important for the medical care and prognosis for this patient.Case report
A 20-year-old white woman was transferred to the Cleveland Clinic after 5 days in a local hospital. She was febrile, had left lower abdominal pain, nausea, vomiting, and diarrhea, and increasing renal failure and oliguria were developing. Juvenile onset diabetes mellitus had been noted since she was 7 years old.
On admission to the medical services, the creatinine level was 7.7 mg/dl and the blood urea nitrogen (BUN) was 84 mg/dl.
The physical examination was difficult because of exquisite lower abdominal tenderness. Urine output had fallen to less than 100 cc/day. Surgical and gynecologic consultants found no evidence of an abdominal mass or indications of an acute surgical abdomen. Several diagnoses were considered including urinary tract infection with obstruction, inflammatory bowel disease, tubal pregnancy, and sepsis. The history of long-term juvenile diabetes indicated the possibility of end-stage renal disease or papillary necrosis. Hemodialysis . . .