Renal keratinising desquamative squamous metaplasia: all that hurts is not stone

Description

A 66-year-old Caucasian man with history of hypertension, hyperlipidaemia and 16 pack-year smoking was referred to us for evaluation of recurrent right-sided flank pain and suspected nephrolithiasis. His first episode of pain was 2 years prior to presentation, which was recurrent. There was no associated haematuria, dysuria, fever, chills, urinary hesitancy or incontinence. There was no family history of stones. He underwent multiple ureteroscopies, which have shown glistening, soft, acellular debris in the upper ureter. Last ureteroscopy and pyeloscopy showed normal underlying mucosa, renal pelvis and calyces with no evidence of malignancy. Subsequent MRI also did not show any malignancy. The last available pathology showed minute fragments of acellular keratin debris. Interestingly, he never had imaging evidence of renal stone, although had mild hydronephrosis one time. CT urogram demonstrated an ill-defined filling defect in the anterior right renal pelvis measuring approximately 13x3 mm in axial dimensions (figure 1). During...

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