renal papillary necrosis

Symptoms (and signs) consistent with renal papillary necrosis are:{{cite web|title=Renal Papillary Necrosis|url=https://www.nlm.nih.gov/medlineplus/ency/article/000488.htm|website=Medline|publisher=NIH|access-date=15 October 2015}}

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• Back pain
• Cloudy urine
• Tissue pieces (in urine)
• Fever
• Painful/frequent urination
• Urinary incontinence

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In terms of cause, almost any condition that involves ischemia can lead to renal papillary necrosis. A mnemonic for the causes of renal papillary necrosis is POSTCARDS: pyelonephritis, obstruction of the urogenital tract, sickle cell disease, tuberculosis, cirrhosis of the liver, analgesia/alcohol use disorder, renal vein thrombosis, diabetes mellitus, and systemic vasculitis.{{Cite book|title = Radiology Illustrated: Uroradiology|url = https://books.google.com/books?id=-NrSgSEQGm8C&q=POSTCARDS%2520%2520renal%2520papillary%2520necrosis&pg=PA471|publisher = Springer Science & Business Media|date = 2011-11-19|page=471|isbn = 9783642053221|first = Seung Hyup|last = Kim}} Often, a patient with renal papillary necrosis will have numerous conditions acting synergistically to bring about the disease.{{cite web|last=Powell|first=Christopher|title=Papillary Necrosis|url=http://emedicine.medscape.com/article/439586|publisher=Medscape Reference|access-date=10 Nov 2011}}

Analgesic nephropathy is a common cause of renal papillary necrosis. The risk is higher for phenacetin (which was withdrawn from market in the United States) and paracetamol (acetaminophen) compared to aspirin and other NSAIDs.{{medical citation needed|date=October 2015}}

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).{{Cite web|title = Analgesic Nephropathy. Chronic kidney disease information. Patient {{!}} Patient|url = http://patient.info/doctor/Analgesic-Nephropathy.htm|website = Patient|access-date = 2015-10-15|language = en-GB}} Papillary necrosis is more likely to develop when multiple of these underlying factors are present.{{Cite book|title = Primer on Kidney Diseases|url = https://books.google.com/books?id=BUE9-mY4FkoC&q=pathophysiology%2520renal%2520papillary%2520necrosis&pg=PA385|publisher = Elsevier Health Sciences|date = 2005-01-01|page=387|isbn = 978-1416023128|first1 = Arthur|last1 = Greenberg|first2 = Alfred K.|last2 = Cheung}} 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.{{Cite journal|url=https://emedicine.medscape.com/article/439586-overview|title=Papillary Necrosis|last=Powell|first=Christopher|date=Jan 12, 2017|website=Medscape}}

Image:Cystoscope-med-20050425.jpg

Individuals with renal papillary necrosis due to excess use of analgesic have an elevated risk of epithelial tumors, hence a urine cytology exam is useful.{{Cite book|title = Campbell-Walsh Urology|url = https://books.google.com/books?id=W1aeyJD46kIC|publisher = Elsevier Health Sciences|date = 2011-09-28|page= 269|isbn = 978-1455722983|first1 = Alan J.|last1 = Wein|first2 = Louis R.|last2 = Kavoussi|first3 = Andrew C.|last3 = Novick|first4 = Alan W.|last4 = Partin|first5 = Craig A.|last5 = Peters}} In terms of imaging this condition can be identified by retrograde pyelography (RGP).{{Cite book|title = Radiology Illustrated: Uroradiology|url = https://books.google.com/books?id=-NrSgSEQGm8C&q=renal%2520papillary%2520necrosis%2520%2520treatment&pg=PA472|publisher = Springer Science & Business Media|date = 2011-11-19|page=472|isbn = 9783642053221|first = Seung Hyup|last = Kim}} The diagnosis of renal papillary necrosis is therefore done via:{{Cite web|title = Papillary Necrosis Workup: Laboratory Studies, Imaging Studies, Diagnostic Procedures|url = http://emedicine.medscape.com/article/439586-workup#c5|website = emedicine.medscape.com|access-date = 2015-10-15}}

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• Urinalysis
• Blood cell count
• Urine cytology study
• Imaging study (with intravenous contrast)
• Cystoscopy
• Ureteroscopy

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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.{{Cite book|title = Diseases of the Kidney and Urinary Tract|url = https://books.google.com/books?id=20DyLuGabJcC|publisher = Lippincott Williams & Wilkins|date = 2007-01-01|page=2008|isbn = 9780781793070|first = Robert W.|last = Schrier}} Control of infection is important, thus antimicrobial treatment is begun, so as to avert surgery (should the infection not respond).{{Cite book|title = Clinical Infectious Disease|url = https://books.google.com/books?id=meFwBwAAQBAJ|publisher = Cambridge University Press|date = 2015-04-23|page=438|isbn = 9781107038912|first = David|last = Schlossberg}}

{{Reflist}}

• {{Cite book|title = Disorders of Hemoglobin: Genetics, Pathophysiology, and Clinical Management|url = https://books.google.com/books?id=Qd_ct5S6htMC|publisher = Cambridge University Press|date = 2009-08-17|isbn = 9780521875196|first1 = Martin H.|last1 = Steinberg|first2 = Bernard G.|last2 = Forget|first3 = Douglas R.|last3 = Higgs}}
• {{Cite journal|title = Nonsteroidal Anti-Inflammatory Drug—Associated Renal Papillary Necrosis in a White-Tailed Deer (Odocoileus Virginianus)|journal = Journal of Veterinary Diagnostic Investigation|date = 2010-05-01|issn = 1040-6387|pmid = 20453233|pages = 476–478|volume = 22|issue = 3|doi = 10.1177/104063871002200328|first1 = Adam W.|last1 = Stern|first2 = Jerry W.|last2 = Ritchey|first3 = Brittany|last3 = Hall|first4 = Cornelia J.|last4 = Ketz-Riley|first5 = Suzanne G.|last5 = Genova|doi-access = }}

{{Medical resources

| DiseasesDB = 9572

| ICD10 = {{ICD10|N|17|2|n|17}}

| ICD9 = {{ICD9|584.7}}

| ICDO =

| OMIM =

| MedlinePlus = 000488

| eMedicineSubj = med

| eMedicineTopic = 2839

| eMedicine_mult = {{eMedicine2|radio|523}}

| MeshID = D007681

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{{Commons}}

{{Scholia|topic}}

{{Urologic disease}}

{{Medicine}}

Category:Kidney diseases