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Abstract: SA-PO594

Acute Renal Papillary Necrosis With New-Onset Minimal Change Disease

Session Information

  • Pediatric Nephrology - II
    November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1800 Pediatric Nephrology

Authors

  • Goswami, Shrea, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, United States
  • Guo, Shunhua, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, United States
  • Roth, Joshua, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, United States
  • Schwaderer, Andrew L., Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, United States
  • Khalid, Myda, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, United States
Introduction

Acute renal papillary necrosis (RPN) is a rare condition in children characterized by renal sloughing of papillae. We present a case of RPN in a healthy 4-year-old girl with new onset minimal change disease (MCD). To our knowledge, RPN as a complication of new onset MCD has not been previously reported.

Case Description

The patient presented with a 4-day history of generalized edema, fatigue and decreased urine output. Pertinent lab findings were albumin of 2.4 mg/dL and UPCR of 27 mg/mg. She had an elevated serum BUN and creatinine of 44 mg/dL and 1.2 mg/dL respectively. Renal bladder ultrasound showed bilateral nephromegaly without hydronephrosis.
Upon hospitalization, she received albumin with furosemide overnight. However, she remained anuric and creatinine rose to 2.9 mg/dL the next day. Repeat renal bladder ultrasound demonstrated bilateral circular isoechoic foci in mid-poles of the kidneys with bladder debris, suspicious for RPN. Double J stents were placed urgently with immediate production of urine. Retrograde pyelogram at the time of stent placement demonstrated multiple collections of contrast in bilateral kidney papillae, specific for RPN. A renal biopsy on day 6 of hospitalization revealed MCD. Common risk factors for RPN such as NSAID use were not present and a hemoglobin electrophoresis was negative. She remained on prednisolone for the MCD and entered remission in one month.

Discussion

To our knowledge we are not aware of any case reports describing RPN as a complication of minimal change disease. The sloughed renal papillae caused an acute bilateral ureteric obstruction. Due to sudden onset of obstruction hydronephrosis did not develop. We speculate that the intravascular volume depletion from MCD triggered a hypoxic state resulting in RPN which is similar to the pathophysiology of severe dehydration induced RPN.