A Nautilus kidney

Clin Exp Nephrol. 2020 Oct;24(10):971-972. doi: 10.1007/s10157-020-01915-7. Epub 2020 Jun 26.


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.

Keywords: Atrophic kidney; ESRD; Pyonephrosis.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Animals
  • Atrophy / complications
  • Female
  • Flank Pain / etiology
  • Humans
  • Hydronephrosis / etiology
  • Kidney / diagnostic imaging*
  • Kidney / pathology
  • Nautilus
  • Pyonephrosis / complications
  • Pyonephrosis / diagnostic imaging*
  • Sepsis / etiology
  • Tomography, X-Ray Computed
  • Ureteral Obstruction / complications