What is renal papillary necrosis?

Renal papillary necrosis is a disorder of the kidneys in which some or all of the renal papillae die. The renal papillae are the areas where the openings of the collecting ducts enter the kidney and where urine flows into the ureters.

Prognosis

The prognosis depends on the severity of the disease. In some cases the condition resolves by itself. In other cases, it may be accompanied by renal failure possibly necessitating a kidney transplant or dialysis.

Symptoms

One possible effect of renal papillary necrosis is that the kidneys are no longer capable of concentrating urine. Symptoms may include the following:

• Back or flank pain
• Blood in the urine
• Cloudy, dark or reddish urine
• Tissue fragments in the urine

Other symptoms may include:

• Fever and chills
• Incontinence
• More frequent need to urinate
• Pain when urinating

Medical tests for renal papillary necrosis

The affected part of the kidney may be tender during examination. Other important aspects are a possible history of urinary tract infection or signs of urinary obstruction and renal failure.

Some of the tests that may be performed are:

• Urine and blood analysis
• Ultrasound, CT scan and other kidney investigations

What are the causes of renal papillary necrosis?

In many cases, it presents in association with analgesic nephropathy. This is damage to one or both kidneys caused by excessive exposure to an analgesic. However, there are other diseases that can also cause renal papillary necrosis, such as:

• Diabetic nephropathy
• Rejection of a kidney transplant
• Kidney infection
• Sickle-cell anaemia, a common cause in children
• Urinary tract obstruction

Can it be prevented?

Regular monitoring of diabetes or sickle-cell anaemia is important, as this will reduce the risk. In relation to renal papillary necrosis due to analgesic nephropathy, prudency and moderation must be exercised when using medications, including over-the-counter analgesics.

Treatment of renal papillary necrosis

There is not a specific treatment for renal papillary necrosis. The cure depends on the cause, whether it can be controlled. The condition might resolve by itself. In other cases, people with this condition will develop renal failure and require dialysis or a kidney transplant.

If the physician suspects that the cause is analgesic nephropathy, they will recommend the discontinuation of the medications, which may eventually lead to cure over time. 

Which specialist treats it?

The specialist who treats renal papillary necrosis is a nephrologist.