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Kidney anatomy
Kidney anatomy
Kidney - blood and urine flow
Kidney - blood and urine flow

Renal papillary necrosis
Definition:
A disorder of the kidney involving death of some or all of the renal papillae.

Alternative Names:
Necrosis - renal papillae; Renal medullary necrosis

Causes, incidence, and risk factors:

The renal papillae are the areas of the kidney where the openings from the collecting ducts enter the renal pelvis. Necrosis (tissue death) of this area may result in impairment of the kidneys ability to concentrate the urine with ensuing polyuria (increased urine volume usually in excess of 3 liters/day) and nocturia (frequent urination at night).

The necrotic tissue may be sloughed off, and it may be present in the urine as tissue, or the tissue may obstruct the renal pelvis or the ureter causing obstruction. Presence of necrotic tissue in the urine increases the risk of urinary tract infections. Necrosis of multiple papillae in the kidney can lead to eventual failure of that kidney.

Renal papillary necrosis is most commonly associated with analgesic nephropathy, diabetic nephropathy, renal transplant rejection, urinary tract obstruction, kidney infections and sickle cell anemia. Sickle cell anemia is a common cause of renal papillary necrosis in children.
Symptoms:
Additional symptoms that may be associated with this disease:
Signs and tests:
An examination may reveal tenderness on palpation over the affected kidney. There may be a history of chronic or recurrent urinary tract infections. There may be signs of obstructive uropathy or renal failure.
Treatment:
There is no specific treatment for renal papillary necrosis. If analgesic nephropathy is suspected as the cause, stop the use of suspected medications. This may allow spontaneous healing over time. If nephropathy is a result of diabetes or sickle cell anemia, control of these disorders is important to reduce renal papillary necrosis. Renal failure should be treated as appropriate. The treatment of chronic or recurrent urinary tract infections may include antibiotics.
Expectations (prognosis):
The probable outcome is varies. If the underlying disorder can be controlled, a spontaneous remission is possible. The progression to renal failure is also possible.
Complications:
Calling your health care provider:
Call for an appointment with your health care provider any time there is bloody urine. Also call if other symptoms of renal papillary necrosis develop, especially after taking over-the-counter analgesics (pain medications).
Prevention:
Control of diabetes or sickle cell anemia may reduce risk. Prevention of renal papillary necrosis from analgesic nephropathy includes careful moderation in the use of medications, including over-the-counter analgesics.
Review Date: 12/2/2001
Reviewed By: Andrew Koren, M.D., Department of Nephrology, NYU-Mount Sinai Medical Center, New York, NY. Review provided by VeriMed Healthcare Network.
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