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

 Renal papillary necrosis (RPN) is a multifactorial complication that occurs under the following conditions: Pyelonephritis, obstruction of the urogenital tract, non-steroidal anti-inflammatory drugs (NSAIDs) abuse, diabetes mellitus (DM2), and coronavirus disease 2019 (COVID-19). The present report presented a case of right ureteral obstruction due to RPN.

 The patient was a 68-year-old woman referred to the hospital due to flank pain, fever, vomiting/nausea, frequency, and nocturia. She also had a history of DM2, hypertension, dialysis, COVID-19, and the use of NSAIDs and antihypertensive. The results of computed tomography (CT) scan suspected a clot, bladder fungus or RPN, and COVID-19. After performing the ultrasound, mild hydroureteronephrosis and two echogenic foci were seen in the right kidney, suggesting a possible RPN. The patient was transferred to the urology service. After cystoscopy and urethroscopy, a severe stenosis was seen in the distal right ureter. As soon as inserting double J, lots of pus came out. The definitive diagnosis was RPN, ureteral obstruction, and pyelonephritis.

 It is important to pay enough attention to the disorders related to the urinary system, especially in the elderly with a history of NSAIDs abuse, DM2, hypertension, COVID-19, and renal diseases. Additionally, the underlying diseases, blood glucose, infection, dehydration, and use of NSAIDs must be well-controlled to protect nephro-ureteral structures.