papillary necrosis

Renal papillary 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.

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.

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.

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.

Alternative Names

Necrosis - renal papillae; Renal medullary necrosis

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.

Update Date: 9/20/2011

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Herbert Y. Lin, MD, PhD, Nephrologist, Massachusetts General Hospital, Associate Professor of Medicine, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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