1. AN UNUSUAL CASE OF RENAL FAILURE Dr.P.ARUL. PG Prof. VIJAYARAGAVAN’s Unit

2. 60 years old female patient Sabira admitted with complaints of Burning micturition For 3 days Abdomen pain Fever

3. H/o Presenting illness : Fever – High grade, intermittent , associated with chills. Abdomen pain – Lower abdomen and also in the flanks. Burning micturition+ No C/o vomiting. No C/o oliguria. No C/o Facial puffiness or leg swelling.

12. DISCUSSION

22. Normal kidney Hypoperfused kidney Does not depend upon local Prostaglandins for adequate perfusion Depend upon local Prostaglandins for adequate perfusion NO EFFRECT RENAL PAPILLARY NECROSIS ANALGESICS – COX1/COX2 INHIBITORS

25. Excretory urography in a patient with renal papillary necrosis and pyeloureteritis cystica. There is bilateral loss of the renal mantle with contrast tracking from the renal fornix in the lower pole of the right kidney. There is also multiple smooth filling defects in the ureter, caused by ureteritis cystica

26. Photograph of a gross section from the right kidney shows abscesses in the cortex (arrowheads) and hemorrhagic infarcts in papillary regions (arrows), findings indicative of pyonephrosis and necrotizing papillitis, respectively.

31. Thank you

32. 9 0 At diagnosis 15 15 Overt nephropathy 38 16 Microalbuminuria Type 2 DM Type 1 DM Prevalence

34. Albuminuria in type 1 DM and development of complications 50 11 58 80 Macroalbuminuria 31 6 28 40 Microalbuminuria 21 1 12 20 Normoalbuminuria Prevalence of neuropathy % Prevalence of blindness % Prevalence of retinopathy % Prevalence of HT % UAER