LAUSR

INTRODUCTION Diabetic renal papillary necrosis (RPN) is challenging to diagnose radiologically due to the limitation in performing a contrast study in patients with compromised renal function. Endoscopic management by double 'J' (DJ) stenting or percutaneous nephrostomy is the preferred treatment. The aim of our study was to analyze the role of Retrograde Intrarenal Surgery (RIRS) in the management of RPN by retrieving necrosed papillae. METHODS This retrospective study included diabetic patients who presented with acute pyelonephritis or urosepsis at our institute. After evaluating with appropriate laboratory and radiological investigations, retrograde pyelography (RGP) and double "J" stenting were performed in those who did not respond to intravenous antibiotic therapy. RIRS was performed in patients who had filling defects in the pelvicalyceal system (PCS) on RGP after 3 weeks at the time of DJ stent removal. Patients with a minimum follow-up period of 6 months were included. RESULTS A total of 187 patients (81 female, 106 male) with diabetes were enrolled in this study with a mean age was 58.3 years. The mean serum creatinine was 2.7 mg/dl and the mean eGFR was 32.8 ml/min/1.73 m2. One hundred and twenty-six patients (67.3%) had hydroureteronephrosis (HUN), out of which 74 (58.7%) had necrosed papillae in the PCS. In 61 (32.6%) patients there was no HUN, however, 25 (41%) of these patients had necrosed papillae in PCS. Necrosed renal papillae were retrieved in 83 patients (46.1%) by RIRS. All the patients were followed up for a minimum period of 6 months; seven patients (3.8%) had recurrent pyelonephritis. CONCLUSIONS RIRS plays a significant role in the management of diabetic RPN. Retrieving necrosed papillae from the PCS after confirming their presence by RGP prevents ureteric obstruction, which leads to urosepsis, and presumptively prevents or delays future episodes of pyelonephritis.