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Renal papillary necrosis

Necrosis - renal papillae; Renal medullary necrosis

 

Renal papillary necrosis is a disorder of the kidneys in which all or part of the renal papillae die. The renal papillae are the areas where the openings of the collecting ducts enter the kidney, and where the urine flows into the ureters.

Causes

 

Renal papillary necrosis usually occurs with analgesic nephropathy. However, a number of other conditions can cause it, including:

  • Diabetic nephropathy
  • Kidney infection (pyelonephritis)
  • Kidney transplant rejection
  • Sickle cell anemia
  • Urinary tract blockage

Sickle cell anemia is a common cause of renal papillary necrosis in children.

 

Symptoms

 

Tissue death (necrosis) of the renal papillae may make the kidney unable to concentrate the urine. Symptoms may include:

  • Back pain or flank pain
  • Bloody urine
  • Cloudy urine
  • Dark, rust-colored, or brown urine
  • Tissue pieces in the urine

Other symptoms that may ocur with this disease:

  • Chills
  • Fever
  • Painful urination
  • Urinary frequency or urgency
  • Urinary hesitancy
  • Urinary incontinence
  • Urinating large amounts
  • Urinating often at night

 

Exams and Tests

 

The area over the affected kidney (in the flank) may feel tender during an exam. There may be a history of urinary tract infections. There may be signs of obstructive uropathy or kidney failure.

A urinalysis may show infection or dead tissue in the urine.

An intravenous pyelogram (IVP) may show a blockage or tissue in the renal pelvis or ureter.

 

Outlook (Prognosis)

 

How well a person does depends on what is causing the condition. If the cause can be controlled, the condition may go away on its own. In some cases, persons with this condition develop kidney failure and will need dialysis or a kidney transplant.

 

Treatment

 

There is no specific treatment for renal papillary necrosis. Treatment depends on the cause. For example, if analgesic nephropathy is the cause, your doctor will recommend that you stop using the medicine that is causing it. This may allow the kidney to heal over time.

 

Possible Complications

 

  • Acute kidney failure
  • Acute bilateral obstructive uropathy
  • Acute unilateral obstructive uropathy
  • Chronic bilateral obstructive uropathy
  • Chronic kidney disease
  • Chronic or recurrent urinary tract infection (UTI)
  • Chronic unilateral obstructive uropathy
  • Hyperkalemia
  • Hypovolemia
  • Metabolic acidosis

 

When to Contact a Medical Professional

 

Call for an appointment with your health care provider if:

  • You have bloody urine
  • You develop other symptoms of renal papillary necrosis, especially after taking over-the-counter pain medications

 

Prevention

 

Controlling diabetes or sickle cell anemia may reduce your risk. To prevent renal papillary necrosis from analgesic nephropathy, be careful when using medications, including over-the-counter pain relievers.

 

 

References

Kanso AA, Abou Hassan NM, Badr KF. Microvascular and macrovascular diseases of the kidney. In: Brenner BM, ed. Brenner and Rector's the Kidney. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 32.

Porter CC, Ayner Ed. Hematologic diseases causing hematuria. In: Kliegman RM, Stanton BF, St. Geme JW III. Schor NF, Behrman RE, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 514.

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            Review Date: 9/8/2013

            Reviewed By: Charles Silberberg, DO, Private Practice specializing in Nephrology, Affiliated with New York Medical College, Division of Nephrology, Valhalla, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

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