Keratinizing desquamative squamous metaplasia in the kidney of a patient with complex spinal cord injury.

CONTEXT: Keratinizing desquamative squamous metaplasia (KDSM) of the upper urinary tract was previously thought, but never proven, to represent a premalignant condition. However, no clear guidelines exist regarding the long-term management and follow up once this rare diagnosis has been made.

FINDINGS: Patients with spinal cord injury often develop a range of risk factors for malignancy of the urinary tract. We present the first reported case of KDSM in the kidney of a 44-year-old man with spinal cord injury whose complex urological history includes previous augmentation cystoplasty, recurrent calculi, infections and indwelling catheters.

CLINICAL RELEVANCE: Recent literature has suggested a move away from the previous mainstay of treatment with radical surgery towards nephron-sparing endoscopic and radiological surveillance. This case highlights the complexity of preserving renal function in a spinal cord injured patient with KDSM of the kidney.