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Symptomatic renal papillary varicosities and medullary nephrocalcinosis

BACKGROUND: Nephrocalcinosis is often asymptomatic but can manifest with renal colic or hematuria. There is no reported association between nephrocalcinosis and renal vascular malformations, which may also be a source of hematuria. We herein present a case of a patient with hematuria related to neph...

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Autores principales: Cleveland, Brent, Borofsky, Michael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8628392/
https://www.ncbi.nlm.nih.gov/pubmed/34844581
http://dx.doi.org/10.1186/s12894-021-00931-3
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author Cleveland, Brent
Borofsky, Michael
author_facet Cleveland, Brent
Borofsky, Michael
author_sort Cleveland, Brent
collection PubMed
description BACKGROUND: Nephrocalcinosis is often asymptomatic but can manifest with renal colic or hematuria. There is no reported association between nephrocalcinosis and renal vascular malformations, which may also be a source of hematuria. We herein present a case of a patient with hematuria related to nephrocalcinosis and renal papillary varicosities. These varicosities were diagnosed and successfully treated with flexible ureteroscopy and laser fulguration. CASE PRESENTATION: A 24-year-old female with a history of epilepsy (on zonisamide), recent uncomplicated pregnancy, and new diagnosis of nephrocalcinosis presented with right flank pain and intermittent gross hematuria. Imaging revealed intermittent right sided hydronephrosis. A cystoscopy identified hematuria from the right ureteral orifice. Diagnostic flexible ureteroscopy revealed numerous intrapapillary renal stones and varicose veins of several renal papillae. A 200 μm holmium laser fiber was used to unroof these stones and fulgurate the varicosities with resolution of her symptoms for several months. She later presented with left-sided symptoms and underwent left ureteroscopy with similar findings and identical successful treatment. CONCLUSION: Unilateral hematuria from discrete vascular lesions of the renal collecting system may be obscured by other benign co-existing conditions, such as nephrocalcinosis and nephrolithiasis. Although a simultaneous presentation is rare, flexible ureteroscopy with laser fulguration offers an ideal diagnostic and therapeutic modality for these concurrent conditions if symptoms arise.
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spelling pubmed-86283922021-12-01 Symptomatic renal papillary varicosities and medullary nephrocalcinosis Cleveland, Brent Borofsky, Michael BMC Urol Case Report BACKGROUND: Nephrocalcinosis is often asymptomatic but can manifest with renal colic or hematuria. There is no reported association between nephrocalcinosis and renal vascular malformations, which may also be a source of hematuria. We herein present a case of a patient with hematuria related to nephrocalcinosis and renal papillary varicosities. These varicosities were diagnosed and successfully treated with flexible ureteroscopy and laser fulguration. CASE PRESENTATION: A 24-year-old female with a history of epilepsy (on zonisamide), recent uncomplicated pregnancy, and new diagnosis of nephrocalcinosis presented with right flank pain and intermittent gross hematuria. Imaging revealed intermittent right sided hydronephrosis. A cystoscopy identified hematuria from the right ureteral orifice. Diagnostic flexible ureteroscopy revealed numerous intrapapillary renal stones and varicose veins of several renal papillae. A 200 μm holmium laser fiber was used to unroof these stones and fulgurate the varicosities with resolution of her symptoms for several months. She later presented with left-sided symptoms and underwent left ureteroscopy with similar findings and identical successful treatment. CONCLUSION: Unilateral hematuria from discrete vascular lesions of the renal collecting system may be obscured by other benign co-existing conditions, such as nephrocalcinosis and nephrolithiasis. Although a simultaneous presentation is rare, flexible ureteroscopy with laser fulguration offers an ideal diagnostic and therapeutic modality for these concurrent conditions if symptoms arise. BioMed Central 2021-11-29 /pmc/articles/PMC8628392/ /pubmed/34844581 http://dx.doi.org/10.1186/s12894-021-00931-3 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Cleveland, Brent
Borofsky, Michael
Symptomatic renal papillary varicosities and medullary nephrocalcinosis
title Symptomatic renal papillary varicosities and medullary nephrocalcinosis
title_full Symptomatic renal papillary varicosities and medullary nephrocalcinosis
title_fullStr Symptomatic renal papillary varicosities and medullary nephrocalcinosis
title_full_unstemmed Symptomatic renal papillary varicosities and medullary nephrocalcinosis
title_short Symptomatic renal papillary varicosities and medullary nephrocalcinosis
title_sort symptomatic renal papillary varicosities and medullary nephrocalcinosis
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8628392/
https://www.ncbi.nlm.nih.gov/pubmed/34844581
http://dx.doi.org/10.1186/s12894-021-00931-3
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