Spontaneous Nephrocutaneous Fistula: A Case Report, Update of the Literature and Management Algorithm

Abstract

Aims: Spontaneous nephrocutaneous fistula (NCF) is a rare and severe condition. The aim of this study was to update the data of the literature about this disease and, reporting and considering also our experience in 1 case of NCF, to make a new clinical algorithm. Methods: This study was done with a review of all the literature and a comparison with our experience. Results: The characteristic sign of spontaneous NCF is a flank sinus discharging material. Physical examination and computed tomography usually lead to the diagnosis. The main predisposing factors are renal stones/staghorn calculi, xanthogranulomatous pyelonephritis and renal tuberculosis. In the vast majority of the cases kidneys are poorly functioning or nonfunctioning. Surgical approach is the common management and usually consists of open nephrectomy. We create a clinical management algorithm obtained by a review of the literature and our experience with spontaneous NCF. Conclusions: Spontaneous NCF represents a very serious renal disease leading to loss of the kidney in the vast majority of cases. We propose a revised and user-friendly clinical diagnostic-therapeutic algorithm for spontaneous NCF based on the worldwide literature.

Asymptomatic Urolithiasis Complicated by Nephrocutaneous Fistula

“…Rare complications of chronic urolithiasis include pelvicalyceal rupture,[2] pyonephrosis,[3] nephrocutaneous fistula (NCF),[456] xanthogranulomatosis pyelonephritis,[789] and renal replacement lipomatosis;[10] their characteristics are summarized in Table 1.…”

“…Other rarer fistulae have been described, for example, a fistula between the kidney and adjacent organs (pleura, colon, or lungs). [6] Asymptomatic spontaneous NCF in renal stone disease is relative common (63%)[5] and only 30% complained of loin pain, but the reason is still unknown. Usually, fistulae development after renal pelvicalyceal rupture relieves pain and diminishes the tensile stress in the collecting system.…”

Gross Hematuria Is More Common in Male and Older Patients with Renal Tuberculosis in China: A Single-Center 15-Year Clinical Experience

“…Similar gender proportions are reported in the literature, showing men to have a prevalence of UGTB twice of women [3,8] . However, among renal TB patients, a gender-related difference has not been well established, and it varies among populations [4][5][6][7][9][10][11][12][13] . In our study, the female/ male ratio was 1.29, which is higher than the ratios of most other studies based in China [10,14,15] .…”

“…All patients underwent surgical treatment and had microbiologic or histologic confirmation of renal TB. The diagnosis and treatment algorithm for the whole study cohort was showed in Figure 1 [11] . The present study was approved by the Institutional Ethics Committee of Peking University First Hospital.…”

Acute Focal Bacterial Nephritis Can Lead to Unnecessary Invasive Procedures: A Report of Three Cases

“…Literature on the subject consisted solely of case reports, and in contrast to other rare infectious diseases of the kidney such as emphysematous pyelonephritis and nephrocutaneous fistulas where certain guidelines on their management are present, no directions are available to guide management [1,2] . We present three cases of AFBN where a diagnosis other than renal infection was initially set.…”