A case of acute renal failure caused by bilateral, multifocal malacoplakia lesions of the bladder and ureters.

BACKGROUND: A 51-year-old woman with a history of hypertension and a 5-year history of recurrent perimenopausal Escherichia coli urinary tract infections presented with fatigue. She had a history of occasional urinary frequency, but denied gross hematuria, flank pain, abdominal pain, immunodeficiency or immunosuppression. INVESTIGATIONS: Basic metabolic profile, ultrasonography, cystoscopy, retrograde pyelography, pathologic evaluation of resected lesions from the bladder, ureteroscopy, pathologic evaluation of resected lesions from the ureters, and MRI. DIAGNOSIS: Acute renal failure caused by bilateral, multifocal malacoplakia lesions of the bladder and ureters. MANAGEMENT: Endoscopic resection and laser ablation, ureteral stent placement, and medical treatment with fluoroquinolones, vitamin C and bethanechol.