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Gross anatomy and histological images showing. (A) Kidney with RPN that appears largely fibrotic with marked chronic interstitial nephritis; (B) inflammatory features are shown in the drawn region as a feature of neutrophil infiltration. In places, aggregates of mononuclear lymphocytes form mature lymphoid follicles. Plasma cells are also present; (C) an image of a kidney with RPN. The indicated white regions are due to lack of blood supply which cause tissue necrosis; (D) an image depicting coagulative necrosis. Ghost cells are denoted by the number 1, 2 depicts foamy macrophages and 3 is neutrophil debris.
Although not confirmed, urological intervention might have an impact on the progression of CKD. Nevertheless, level 4 evidence from expert endourologists have identified the nephrotoxicity of contrast agents causing contrast induced nephropathy. Other factors such as intra-abdominal pressure, radiation, guide wire use, stents, basket, and laser lithotripsy may also contribute to the development of RPN [56,57,58,59]. Examples include a forgotten ureteral stent due to lack of patient education or poor follow-up after ureteral stenting. The management of neglected stents needs sophisticated complex endourological procedures for which experts are usually not available in Africa . Indeed, some urological training programs in Sub-Saharan Africa have limited endoscopic training capacity. In addition, some centers still consider open surgery with its high morbidity on the kidney . The narrowed therapeutic window of calcineurin inhibitors (CNI) immunosuppression after renal transplantation is associated with long-term nephrotoxicity, hypertension, and metabolic disorders including the following features on histology: epithelial necrosis, thrombotic microangiopathy, interstitial fibrosis, tubular atrophy, and premature graft failure . Furthermore, in black African patients higher required doses of tacrolimus further increases the risk for RPN . 59ce067264