Renal papillary necrosis

Other names| Renal medullary necrosis[1]
Frontal section through the kidney
Symptoms| Back pain, cloudy urine[1]
Causes| Diabetic nephropathy, Kidney infection[1]
Diagnostic method| Blood and urine test[1]
Treatment| Depends on cause[1]

Renal papillary necrosis is a form of nephropathy involving the necrosis of the renal papilla.[1] Lesions that characterize renal papillary necrosis come from an impairment of the blood supply and from subsequent ischemic necrosis that is diffuse.[2]

## Contents

* 1 Signs and symptoms
* 2 Causes
* 3 Pathophysiology
* 4 Diagnosis
* 5 Treatment
* 6 References
* 7 Further reading
* 8 External links

## Signs and symptoms

Symptoms (and signs) consistent with renal papillary necrosis are:[1]

* Back pain
* Cloudy urine
* Tissue pieces (in urine)
* Fever
* Painful/frequent urination
* Urinary incontinence
* Hematuria

However, patients may not specifically present any of the aforementioned signs and may instead present an array of abnormal urinary complications such as urinary retention and macroscopic hematuria, in which case it is important to consider this disease as a diagnosis of exclusion. [3]

## Causes

In terms of cause, almost any condition that involves ischemia can lead to renal papillary necrosis. A mnemonic for the causes of renal papillary necrosis is POSTCARDS: pyelonephritis, obstruction of the urogenital tract, sickle cell disease, tuberculosis, cirrhosis of the liver, analgesia/alcohol use disorder, renal vein thrombosis, diabetes mellitus, and systemic vasculitis.[4] Often, a patient with renal papillary necrosis will have numerous conditions acting synergistically to bring about the disease.[5]

Analgesic nephropathy is a common cause of renal papillary necrosis. The risk is higher for phenacetin (which was withdrawn from market in the United States) and paracetamol (acetaminophen) compared to aspirin and other NSAIDs.

## Pathophysiology

This condition is due to ischemia of the renal papillae, the portion of the kidney that collects urine from the nephron. The papillae are vulnerable to ischemia as they are supplied by small caliber arteries which are liable to obstruction. All of the underlying causes of papillary necrosis cause diminished flow through these arteries, either through direct mechanical obstruction (sickle cell), obstruction secondary to inflammation (vasculitides), or vasoconstriction (NSAIDs).[6] Papillary necrosis is more likely to develop when multiple of these underlying factors are present.[7] Ultimately, necrosis of the papillae results in sloughing into the lumen, causing hematuria. If the degree of necrosis is substantial post-renal failure may occur, though this is uncommon.[8]

## Diagnosis

Cystoscope

Individuals with renal papillary necrosis due to excess use of analgesic have an elevated risk of epithelial tumors, hence a urine cytology exam is useful.[9] In terms of imaging this condition can be identified by retrograde pyelography (RGP).[10] Further, radiological imaging, particularly CT scanning, can provide an effective method for early diagnosis, ultimately allowing for more timely intervention and more successful treatment outcomes.[11] The diagnosis of renal papillary necrosis is therefore done via:[12]

* Urinalysis
* Blood cell count
* Urine cytology study
* Imaging study (with intravenous contrast)
* Cystoscopy
* Ureteroscopy

## Treatment

Progressive renal papillary necrosis may result in irreversible tissue damage, obstruction, and a decline in renal function, and in severe cases when both kidneys are affected, it can lead to kidney failure.[13] Treatment of renal papillary necrosis is supportive, any obstruction (ureteral) can be dealt with via stenting. Control of infection is important, thus antimicrobial treatment is begun, so as to avert surgery (should the infection not respond).[14]

## References

1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 "Renal Papillary Necrosis". NIH. https://www.medlineplus.gov/ency/article/000488.htm.
2. ↑ Jung, Dae Chul; Kim, Seung Hyup; Jung, Sung Il; Hwang, Sung Il; Kim, Sun Ho (November 2006). "Renal Papillary Necrosis: Review and Comparison of Findings at Multi–Detector Row CT and Intravenous Urography1". RadioGraphics 26 (6): 1827–1836. doi:10.1148/rg.266065039. PMID 17102053.
3. ↑ Tallai, B.; Gulistan, T. G.; Alrayashi, M. N. A. B.; Al Mughalles, S. A. A.; Kamkoum, H. M.; Ebrahim, M. A. A.; Abdelkarim, M. A. A.; Salah, M. A. (2021). "A Rare Presentation of Renal Papillary Necrosis in a COVID-19-Positive Patient". Case Reports in Urology 2021 (1): 1–4. doi:10.1155/2021/6611861. PMID 33489409.
4. ↑ Kim, Seung Hyup (2011-11-19). Radiology Illustrated: Uroradiology. Springer Science & Business Media. p. 471. ISBN 9783642053221. https://books.google.com/books?id=-NrSgSEQGm8C&q=POSTCARDS%20%20renal%20papillary%20necrosis&pg=PA471.
5. ↑ Powell, Christopher. "Papillary Necrosis". Medscape Reference. http://emedicine.medscape.com/article/439586.
6. ↑ "Analgesic Nephropathy. Chronic kidney disease information. Patient | Patient" (in en-GB). http://patient.info/doctor/Analgesic-Nephropathy.htm.
7. ↑ Greenberg, Arthur; Cheung, Alfred K. (2005-01-01). Primer on Kidney Diseases. Elsevier Health Sciences. p. 387. ISBN 978-1416023128. https://books.google.com/books?id=BUE9-mY4FkoC&q=pathophysiology%20renal%20papillary%20necrosis&pg=PA385.
8. ↑ Powell, Christopher (Jan 12, 2017). Papillary Necrosis. https://emedicine.medscape.com/article/439586-overview. Retrieved March 4, 2019.
9. ↑ Wein, Alan J.; Kavoussi, Louis R.; Novick, Andrew C.; Partin, Alan W.; Peters, Craig A. (2011-09-28). Campbell-Walsh Urology. Elsevier Health Sciences. p. 269. ISBN 978-1455722983. https://books.google.com/books?id=W1aeyJD46kIC.
10. ↑ Kim, Seung Hyup (2011-11-19). Radiology Illustrated: Uroradiology. Springer Science & Business Media. p. 472. ISBN 9783642053221. https://books.google.com/books?id=-NrSgSEQGm8C&q=renal%20papillary%20necrosis%20%20treatment&pg=PA472.
11. ↑ Sutariya, Harsh; Pandya, Vaidehi (Jan 2016). "Renal Papillary Necrosis: Role of Radiology". Journal of Clinical and Diagnostic Research 10 (1): 10–12. doi:10.7860/JCDR/2016/15092.7091. PMID 26894147. PMC 4740675. https://doi.org/10.7860/JCDR/2016/15092.7091.
12. ↑ "Papillary Necrosis Workup: Laboratory Studies, Imaging Studies, Diagnostic Procedures". http://emedicine.medscape.com/article/439586-workup#c5.
13. ↑ Geller, S. A.; Campos, F. P. F. D (2013). "Renal papillary necrosis". Autopsy and Case Reports 3 (4): 69–71. doi:10.4322/acr.2013.042. PMID 28584810.
14. ↑ Schlossberg, David (2015-04-23). Clinical Infectious Disease. Cambridge University Press. p. 438. ISBN 9781107038912. https://books.google.com/books?id=meFwBwAAQBAJ.

## Further reading

* Steinberg, Martin H.; Forget, Bernard G.; Higgs, Douglas R. (2009-08-17). Disorders of Hemoglobin: Genetics, Pathophysiology, and Clinical Management. Cambridge University Press. ISBN 9780521875196. https://books.google.com/books?id=Qd_ct5S6htMC.
* Stern, Adam W.; Ritchey, Jerry W.; Hall, Brittany; Ketz-Riley, Cornelia J.; Genova, Suzanne G. (2010-05-01). "Nonsteroidal Anti-Inflammatory Drug—Associated Renal Papillary Necrosis in a White-Tailed Deer (Odocoileus Virginianus)". Journal of Veterinary Diagnostic Investigation 22 (3): 476–478. doi:10.1177/104063871002200328. ISSN 1040-6387. PMID 20453233.

## External links

Classification|

* ICD-10: N17.2
* ICD-9-CM: 584.7
* MeSH: D007681
* DiseasesDB: 9572

|

External resources|

* MedlinePlus: 000488
* eMedicine: med/2839 radio/523

| Wikimedia Commons has media related to Renal papillary necrosis.

|

| Scholia has a topic profile for Renal papillary necrosis.

|

* v
* t
* e

Diseases of the urinary system (N00–N39, 580–599)

Kidney disease|

| Glomerules|

| Primarily
nephrotic|

| Non-proliferative|

* Minimal change
* Focal segmental
* Membranous

|

Proliferative|

* Mesangial proliferative
* Endocapillary proliferative
* Membranoproliferative/mesangiocapillary

By condition|

* Diabetic
* Amyloidosis

Primarily
nephritic,
RPG|

| Type I RPG/Type II hypersensitivity|

* Goodpasture's syndrome

|

Type II RPG/Type III hypersensitivity|

* Post-streptococcal
* Lupus
* DPGN
* IgA/Berger's

Type III RPG/Pauci-immune|

* Granulomatosis with polyangiitis
* Microscopic polyangiitis
* Eosinophilic granulomatosis with polyangiitis

General|

* glomerulonephritis
* glomerulonephrosis

Tubules|

* Renal tubular acidosis
* proximal
* distal
* Acute tubular necrosis
* Genetic
* Fanconi syndrome
* Bartter syndrome
* Gitelman syndrome
* Liddle's syndrome

Interstitium|

* Interstitial nephritis
* Pyelonephritis
* Balkan endemic nephropathy

General|

| General syndromes|

* Nephritis
* Nephrosis
* Renal failure
* Acute renal failure
* Chronic kidney disease
* Uremic pericarditis
* Uremia
* Diabetes insipidus
* Nephrogenic
* Renal papilla
* Renal papillary necrosis
* Major calyx/pelvis
* Hydronephrosis
* Pyonephrosis
* Reflux nephropathy

|

Vascular|

* Renal artery stenosis
* Renal ischemia
* Hypertensive nephropathy
* Renovascular hypertension
* Renal cortical necrosis

Other|

* Analgesic nephropathy
* Renal osteodystrophy
* Nephroptosis
* Abderhalden–Kaufmann–Lignac syndrome

Urinary tract|

| Ureter|

* Ureteritis
* Ureterocele
* Megaureter

|

Bladder|

* Cystitis
* Interstitial cystitis
* Hunner's ulcer
* Trigonitis
* Hemorrhagic cystitis
* Neurogenic bladder dysfunction
* Bladder sphincter dyssynergia
* Vesicointestinal fistula
* Vesicoureteral reflux

Urethra|

* Urethritis
* Non-gonococcal urethritis
* Urethral syndrome
* Urethral stricture/Meatal stenosis
* Urethral caruncle

Any/all|

* Obstructive uropathy
* Urinary tract infection
* Retroperitoneal fibrosis
* Urolithiasis
* Bladder stone
* Kidney stone
* Renal colic
* Malakoplakia
* Urinary incontinence
* Stress
* Urge
* Overflow

* v
* t
* e

Medicine

Specialties
and
subspecialties|

Surgery

* Cardiac surgery
* Cardiothoracic surgery
* Colorectal surgery
* Eye surgery
* General surgery
* Neurosurgery
* Oral and maxillofacial surgery
* [[[Medicine:Orthopedic surgery|Orthopedic surgery]]
* Hand surgery
* Otolaryngology
* ENT
* Pediatric surgery
* Plastic surgery
* Reproductive surgery
* Surgical oncology
* Thoracic surgery
* Transplant surgery
* Trauma surgery
* Urology
* Andrology
* Vascular surgery

Internal medicine

* Allergy / Immunology
* Angiology
* Cardiology
* Endocrinology
* Gastroenterology
* Hepatology
* Geriatrics
* Hematology
* Hospital medicine|
* Infectious disease
* Nephrology
* Oncology
* Pulmonology
* Rheumatology

Obstetrics and gynaecology

* Gynaecology
* Gynecologic oncology
* Maternal–fetal medicine
* Obstetrics
* Reproductive endocrinology and infertility
* Urogynecology

Diagnostic

* Radiology
* Interventional radiology
* Nuclear medicine
* Pathology
* Anatomical
* Clinical pathology
* Clinical chemistry
* Clinical immunology
* Cytopathology
* Medical microbiology
* Transfusion medicine

Other specialties

* Addiction medicine
* Adolescent medicine
* Anesthesiology
* Dermatology
* Disaster medicine
* Diving medicine
* Emergency medicine
* Mass gathering medicine
* Family medicine
* General practice
* Hospital medicine
* Intensive care medicine
* Medical genetics
* Narcology
* Neurology
* Clinical neurophysiology
* Occupational medicine
* Ophthalmology
* Oral medicine
* Pain management
* Palliative care
* Pediatrics
* Neonatology
* Physical medicine and rehabilitation
* PM&R
* Preventive medicine
* Psychiatry
* Addiction psychiatry
* Radiation oncology
* Reproductive medicine
* Sexual medicine
* Sleep medicine
* Sports medicine
* Transplantation medicine
* Tropical medicine
* Travel medicine
* Venereology

Medical education|

* Medical school
* Bachelor of Medicine, Bachelor of Surgery
* Bachelor of Medical Sciences
* Master of Medicine
* Master of Surgery
* Doctor of Medicine
* Doctor of Osteopathic Medicine
* MD–PhD

Related topics|

* Alternative medicine
* Allied health
* Dentistry
* Podiatry
* Physiotherapy
* Molecular oncology
* Nanomedicine
* Personalized medicine
* Public health
* Traditional medicine
* Veterinary medicine
* Physician
* Chief physician
* History of medicine

* Book
* Category
* Commons
* Wikiproject
* Portal
* Outline

0.00

(0 votes)

Original source: https://en.wikipedia.org/wiki/Renal papillary necrosis. Read more

|

Retrieved from "https://handwiki.org/wiki/index.php?title=Medicine:Renal_papillary_necrosis&oldid=4578205"
*[v]: View this template
*[t]: Discuss this template
*[e]: Edit this template