Abstract
According to Kuribayashi's review in 1976, only 51 cases of renal papillary necrosis have been reported in Japan. The incidence of diabetes in those cases was very high. Only 3 cases were diagnosed by detection of the necrotic papillae in the urine.
The authors present here a patient with diabetic triopathy who developed renal papillary necrosis which was suspected by the excretion of necrotic tissue in the urine.
Case report: A 49 year old man, having a diabetic family history, was pointed out diabetes mellitus at 38 year old. Since this time he has been treated temporary with the insulin. At 47 year old in 1974, he was first admitted to our clinic with the chief complaints of thirst and polydipsia. At this time diabetic triopathy was obvious. Insulin therapy was initiated again and the patient had a good control. During the subsequent course of ambulatory therapy, he developed the urinary tract infection, and readmitted November in 1976.
A culture of the urine yielded an abundant growth of pseudomonas (4.3×104). Because of the progression of azotemia hemodialysis therapy was intiated. During this therapy, the patient excreated the tissue fragment 8×5 mm in size in the urine. On the 49th day of the admission, he died of uremia. At autopsy, renal papillary necrosis (medullary form) was confirmed in both kidneys. In addition nodular changes of the glomeruli, hyalinosis of the arterio-arterial wall in the kidneys were found. In the pancreas there were a decrease in the number of Langerhans islet and partial hyalinosis of Langerhans islet.
