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Point-of-Care Kidney and Genitourinary Ultrasound in Adults: Image Acquisition

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Malacoplakia presenting with obstructive nephropathy with bilateral ureter involvement.

Lorin M Sanchez¹, Sean I Sanchez, James L Bailey

¹Emory University School of Medicine, Renal Division, Atlanta, GA 30322-2525, USA. lmsanch@emory.edu

Nature Reviews. Nephrology

|June 27, 2009

Summary

A woman with chronic urinary tract infections developed uremia due to malacoplakia affecting her ureters and bladder. Treatment involved hemodialysis, nephrostomy tubes, and antibiotics.

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Area of Science:

Nephrology
Urology
Infectious Diseases

Background:

A 48-year-old woman with a history of chronic urinary tract infections presented with uremia.
Imaging revealed bilateral hydronephrosis and segmental ureteral thickening, indicating significant urinary tract obstruction.

Observation:

Diagnostic workup included extensive physical examination, laboratory analyses (urine and blood), and advanced imaging (chest and abdominal/pelvic CT, renal ultrasonography).
Procedures such as cystoscopy and anterograde pyelogram were performed, along with a bladder biopsy for definitive diagnosis.

Findings:

The patient was diagnosed with malacoplakia involving both ureters and the bladder.
Concurrently, cavitary pneumonia was identified, suggesting a systemic inflammatory or infectious process.

Implications:

Management strategies included hemodialysis for uremia, bilateral percutaneous nephrostomy tubes for urinary drainage, and a treatment regimen of ciprofloxacin, ascorbic acid, and bethanechol.
This case highlights the importance of considering rare conditions like malacoplakia in patients with chronic UTIs and obstructive uropathy.