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Renal papillary necrosis Causes and Risks:
The renal papillae are the areas of the kidney where the openings from the collecting ducts enter the renal pelvis. Necrosis (tissue death) of this area allows urine to leave the renal tubules before passing through the parts of the tubules that are responsible for concentrating, diluting, and acidifying the urine.
The necrotic tissue may be sloughed off, and it may be present in the urine as tissue, or the tissue may obstruct the renal pelvis or the ureter causing obstructive nephropathy . Presence of necrotic tissue in the urine increases the risk of urinary tract infections . Necrosis of multiple papillae in the kidney can lead to eventual failure of that kidney.
Renal papillary necrosis occurs in about 2 out of 10,000 people. It is most commonly associated with analgesic nephropathy . It also occurs in diabetic nephropathy , and the risk is increased when there is a history of sickle cell anemia . Sickle cell anemia is a common cause of renal papillary necrosis in children.
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 .
Symptoms:
Additional symptoms that may be associated with this disease:
Signs and Tests:
An examination may reveal tenderness on palpation 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 .
Treatment:
There is no specific treatment for renal papillary necrosis. If analgesic nephropathy is suspected as the cause, stop the use of suspected medications. This may allow spontaneous healing over time. If nephropathy is a result of diabetes or sickle cell anemia , control of these disorders is important to reduce renal papillary necrosis. Renal failure should be treated as appropriate. The treatment of chronic or recurrent urinary tract infections may include antibiotics.
Prognosis:
The probable outcome is varies. If the underlying disorder can be controlled, a spontaneous remission is possible. The progression to renal failure is also possible.
Complications:
Call Your Healthcare Provider:
Call for an appointment with your health care provider any time there is bloody urine . Also call if other symptoms of renal papillary necrosis develop, especially after taking over-the-counter analgesics ( pain medications ).
The kidneys are responsible for removing wastes from the body, regulating electrolyte balance and blood pressure, and the stimulation of red blood cell production. The gross anatomical structure of the kidney is illustrated.
This is the typical appearance of the blood vessels (vasculature) and urine flow pattern in the kidney. The blood vessels are shown in red and the urine flow pattern in yellow.
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