renal papillary necrosis associated with multiple risk factors: a case report

Introduction: renal papillary necrosis (rpn) is a multifactorial complication that occurs under the following conditions: pyelonephritis, obstruction of the urogenital tract, non-steroidal anti-inflammatory drugs (nsaids) abuse, diabetes mellitus (dm2), and coronavirus disease 2019 (covid-19). the present report presented a case of right ureteral obstruction due to rpn. case presentation: the patient was a 68-year-old woman referred to the hospital due to flank pain, fever, vomiting/nausea, frequency, and nocturia. she also had a history of dm2, hypertension, dialysis, covid-19, and the use of nsaids and antihypertensive. the results of computed tomography (ct) scan suspected a clot, bladder fungus or rpn, and covid-19. after performing the ultrasound, mild hydroureteronephrosis and two echogenic foci were seen in the right kidney, suggesting a possible rpn. the patient was transferred to the urology service. after cystoscopy and urethroscopy, a severe stenosis was seen in the distal right ureter. as soon as inserting double j, lots of pus came out. the definitive diagnosis was rpn, ureteral obstruction, and pyelonephritis. conclusions: it is important to pay enough attention to the disorders related to the urinary system, especially in the elderly with a history of nsaids abuse, dm2, hypertension, covid-19, and renal diseases. additionally, the underlying diseases, blood glucose, infection, dehydration, and use of nsaids must be well-controlled to protect nephro-ureteral structures.