Renal papillary necrosis
| Renal papillary necrosis | |
|---|---|
| Other names | Renal medullary necrosis[1] |
 | |
| Frontal section through the kidney | |
| Specialty | Urology, nephrology  |
| 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
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
Causes
In terms of cause, almost any condition that involves
diabetes mellitus, and systemic vasculitis.[3] Often, a patient with renal papillary necrosis will have numerous conditions acting synergistically to bring about the disease.[4]
NSAIDs.[medical citation needed
]
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).[5] Papillary necrosis is more likely to develop when multiple of these underlying factors are present.[6] 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.[7]
Diagnosis
Individuals with renal papillary necrosis due to excess use of
epithelial tumors, hence a urine cytology exam is useful.[8] In terms of imaging this condition can be identified by retrograde pyelography (RGP).[9] The diagnosis of renal papillary necrosis is therefore done via:[10]
- Urinalysis
- Blood cell count
- Urine cytologystudy
- Imaging study (with intravenouscontrast)
- Cystoscopy
- Ureteroscopy
Treatment
Treatment of renal papillary necrosis is supportive, any obstruction (ureteral) can be dealt with via
stenting. This condition is not linked to a higher possibility of kidney failure.[11] Control of infection is important, thus antimicrobial treatment is begun, so as to avert surgery (should the infection not respond).[12]
References
- ^ a b c d e f g "Renal Papillary Necrosis". Medline. NIH. Retrieved 15 October 2015.
- PMID 17102053.
- ISBN 9783642053221.
- ^ Powell, Christopher. "Papillary Necrosis". Medscape Reference. Retrieved 10 Nov 2011.
- ^ "Analgesic Nephropathy. Chronic kidney disease information. Patient | Patient". Patient. Retrieved 2015-10-15.
- ISBN 978-1416023128.
- ^ Powell, Christopher (Jan 12, 2017). "Papillary Necrosis". Medscape.
- ISBN 978-1455722983.
- ISBN 9783642053221.
- ^ "Papillary Necrosis Workup: Laboratory Studies, Imaging Studies, Diagnostic Procedures". emedicine.medscape.com. Retrieved 2015-10-15.
- ISBN 9780781793070.
- ISBN 9781107038912.
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.
- 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. PMID 20453233.
External links
Scholia has a topic profile for Renal papillary necrosis.
