Renal papillary necrosis

Renal papillary necrosis is selective tissue death of the renal papilla causing a nephropathy. 

Presentation may be with loin pain and haematuria. It can cause both acute and chronic renal failure. 

Causes: 

• Most common: 
• Analgesic overuse
• Urinary tract obstruction 
• Diabetes 
• Sickle cell 
• Other: 
• Cirrhosis 
• TB 
• SLE 

Pyelonephritis is often listed as a cause but this is controversial – it is difficult to determine if it is in fact a cause or an effect. 

Investigation is with IVU or CT. 

Urine may show a sterile pyuria.

References:

Jung, D. et al. Renal papillary necrosis: review and comparison of findings atmulti-detector row CT and intravenous urography. Radiographics. 2008; 26(6): 1827-1836. 

Griffin, M., Bergstraihn, E.. and Larson, T. Renal papillary necrosis – a sixteen year clinical experience. J Am Soc Nephrol. 1995; 6(2): 248-256.