Abstract: PUB020
Reading Between the Lines: A Curious Case of a Striated Nephrogram
Session Information
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Brim, Rebecca M., University of Utah Health, Salt Lake City, Utah, United States
- Drury, Zachary, University of Utah Health, Salt Lake City, Utah, United States
- Barry, Marc, University of Utah Health, Salt Lake City, Utah, United States
- Fatima, Hira, University of Utah Health, Salt Lake City, Utah, United States
- Ramkumar, Nirupama, University of Utah Health, Salt Lake City, Utah, United States
Introduction
A striated nephrogram on CT or MRI imaging is characterized by linear bands of alternating enhancement from the cortex to medulla reflecting altered perfusion or tubular flow. This can be seen in acute pyelonephritis, urinary obstruction, renal vein thrombosis or renal contusion. We present a case with striated nephrograms resulting from flank pain AKI syndrome from alcohol ingestion and NSAID use.
Case Description
A 22-year-old male presented to the ED with back pain and was found to have an elevated creatinine of 1.32 mg/dl from a baseline creatinine of 0.9 mg/dl two months prior. CT scan without contrast did not show renal abnormalities. He was treated with 2L of IVF and discharged. Two days later the patient returned to the ED with back pain, right greater than left, with worsening creatinine to 2.43 mg/dl. CT with IV contrast showed bilateral striated nephrograms, right greater than left (image 1) and no other abnormalities. Urine analysis showed trace blood and protein with no evidence of infection. Kidney biopsy showed moderate acute tubular necrosis with areas of cytoplasmic vacuolization with no other abnormalities. The patient was non-oliguric and did not require dialysis. All other serological work-up was negative. Creatinine spontaneously was down trending to 1.17 seven days after presentation at a follow-up. History was significant for alcohol consumption and naproxen intake 2 days prior to first ED visit. There was no history of trauma or vigorous exercise.
Discussion
AKI presenting with flank pain and ATN after heavy ETOH use combined with NSAIDs has been reported in a few case reports. Most report spontaneous recovery. The striated nephrogram in our patient was likely due to ATN. A similar presentation is described with AKI with loin pain and patchy renal ischemia after anaerobic exercise (ALPE) in Asian populations with characteristic striated nephrograms.