Definition of Renal papillary necrosis:

Renal papillary necrosis is a disorder of the kidneys in which all or part renal papillae die. The renal papillae is the area where the openings of the collecting ducts enter the kidney.

Causes, incidence, and risk factors:

Renal papillary necrosis is most commonly associated with analgesic nephropathy. However, a number of conditions can cause this condition, including:

• Diabetic nephropathy
• Kidney infection
• Kidney transplant rejection
• Urinary tract obstruction
• Sickle cell anemia

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

Symptoms:

Necrosis (tissue death) 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 in the urine

Additional symptoms that may be associated with this disease:

• Chills
• Incontinence
• Increased urinary frequency or urgency
• Painful urination
• Passing large amounts of urine
• Urinating frequently at night
• Urinary hesitancy

Signs and tests:

An examination may reveal tenderness when touching the body 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.

A urinalysis may show dead tissue in the urine.

An IVP may show obstruction or tissue in the renal pelvis or ureter.

Treatment:

There is no specific treatment for renal papillary necrosis. Treatment depends on the underlying cause. For example, if analgesic nephropathy is suspected as the cause, your doctor will recommend that you stop using the suspected medications. This may allow healing over time.

Expectations (prognosis):

How well a person does depends on the underlying condition. If the underlying disorder can be controlled, the condition may go away on its own. In some cases, persons with this condition develop kidney failure.

Complications:

• Acute kidney failure
• Chronic kidney failure
• Acute unilateral obstructive uropathy
• Chronic unilateral obstructive uropathy
• Acute bilateral obstructive uropathy
• Chronic bilateral obstructive uropathy
• Chronic or recurrent UTI
• Hyperkalemia
• Hypovolemia
• Metabolic acidosis

Calling your health care provider:

Call for an appointment with your health care provider if you have bloody urine. Also call if other symptoms of renal papillary necrosis develop, especially after taking over-the-counter 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.