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In terms of cause, almost any condition that involves ischemia can lead to renal papillary necrosis. A mnemonic for the causes of renal papillary necrosis is POSTCARDS: pyelonephritis, obstruction of the urogenital tract, sickle cell disease, tuberculosis, cirrhosis of the liver, analgesia/alcohol use disorder, renal vein thrombosis, diabetes mellitus, and systemic vasculitis. [3]
Nephrocalcinosis is diagnosed for the most part by imaging techniques. The imagings used are ultrasound (US), abdominal plain film and CT imaging. [10] Of the 3 techniques CT and US are the preferred modalities. In some cases a renal biopsy is done instead if imaging is not enough to confirm nephrocalcinosis.
Urinalysis, microalbumin to creatinine ratio, quantification of urine protein and ultrasound (to exclude obstructive nephropathy and detect papillary necrosis) are methods used to determine renal function. [7] Early signs include abnormally large and distended glomeruli causing hyperfiltration from as young as two years old. [5]
Gross examination often shows a yellowish, multilobulated tumor in the renal cortex, which frequently contains zones of necrosis, haemorrhage and scarring. In a microscopic context, there are four major histologic subtypes of renal cell cancer: clear cell (conventional RCC, 75%), papillary (15%), chromophobic (5%), and collecting duct (2%).
Papillary RCC, a renal tumour that accounts for 10-15% of all RCCs. Males are 1.5 times as likely to develop this type of tumour than females. Papillary RCCs, usually lead to a better prognosis than clear cell RCCs unless the tumour has metastasized. Chromophobe RCC, a kidney tumour with usually the best outcome of prognosis.
Ultrasound findings that indicate pyelonephritis are enlargement of the kidney, edema in the renal sinus or parenchyma, bleeding, loss of corticomedullary differentiation, abscess formation, or an areas of poor blood flow on doppler ultrasound. [21] However, ultrasound findings are seen in only 20–24% of people with pyelonephritis. [21]
Clinical symptoms in patients with pyonephrosis can range from frank sepsis (15%) to asymptomatic bacteriuria.Upon physical examination, the hydronephrotic kidney may be linked to a palpable abdominal mass. [4]
Renal tubular acidosis (RTA) is a medical condition that involves an accumulation of acid in the body due to a failure of the kidneys to appropriately acidify the urine. [1] In renal physiology, when blood is filtered by the kidney, the filtrate passes through the tubules of the nephron, allowing for exchange of salts, acid equivalents, and other solutes before it drains into the bladder as urine.