We report a 71-year-old woman who presented with unilateral flank pain and sepsis. A computed tomographic (CT) scan demonstrated left-sided hydronephrosis. Subsequent percutaneous nephrotomy drainage showed pus-like material, confirming the diagnosis of pyonephrosis. The ureteral stricture was caused by previous radiation injury for cervical cancer in this ESRD patient who was on chronic dialysis for years. In our case, the grade IVB hydronephrosis is a result of an extremely atrophic kidney, pyonephrosis, and ureteral stricture. The CT section of pyonephrosis in an extremely atrophic kidney resembles a sagittal section of a Nautilus shell, as the shell corresponds to the diffusely thinned renal cortex.
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This work was in part supported financially for research purposes by the "Yin Yen-Liang Development and Construction Plan" of the School of Medicine, National Yang-Ming University, Taipei, Taiwan (107F-M01-0504), the Ministry of Science and Technology, Taipei, Taiwan (MOST 108-2633-B-009-001), Taipei Veterans General Hospital, Taipei, Taiwan (V106D25-003-MY3 and VGHUST109-V5-1-2), and the "Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B)" from The Featured Areas Research Center Program, MOE in Taiwan.
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Wu, B., Ho, Y. & Yang, C. A Nautilus kidney. Clin Exp Nephrol (2020). https://doi.org/10.1007/s10157-020-01915-7
- Atrophic kidney