Renal papillary necrosis
Renal papillary necrosis | |
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Other names: Renal medullary necrosis[1] | |
Frontal section through the kidney | |
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 nephropathy involving the necrosis of the renal papilla.[1] Lesions that characterize renal papillary necrosis come from an impairment of the blood supply and from subsequent ischemic necrosis that is diffuse.[2]
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 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.[3] Often, a patient with renal papillary necrosis will have numerous conditions acting synergistically to bring about the disease.[4]
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 The risk is higher for phenacetin (which was withdrawn from market in the United States) and paracetamol (acetaminophen) compared to aspirin and other NSAIDs.[medical citation needed]
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
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a)Bilateral papillary necrosis b)appearance of a normal papilla
-
Cystoscope
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.[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 cytology study
- Imaging study (with intravenous contrast)
- Cystoscopy
- Ureteroscopy
Treatment
Treatment of renal papillary necrosis is supportive, any obstruction (urethral) 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
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 "Renal Papillary Necrosis". Medline. NIH. Archived from the original on 5 July 2016. Retrieved 15 October 2015. Archived 5 July 2016 at the Wayback Machine
- ↑ Jung, Dae Chul; Kim, Seung Hyup; Jung, Sung Il; Hwang, Sung Il; Kim, Sun Ho (November 2006). "Renal Papillary Necrosis: Review and Comparison of Findings at Multi–Detector Row CT and Intravenous Urography1". RadioGraphics. 26 (6): 1827–1836. PMID 17102053.
- ↑ Kim, Seung Hyup (2011-11-19). Radiology Illustrated: Uroradiology. Springer Science & Business Media. p. 471. ISBN 9783642053221. Archived from the original on 2022-05-18. Retrieved 2022-01-30.
- ↑ Powell, Christopher. "Papillary Necrosis". Medscape Reference. Archived from the original on 18 May 2022. Retrieved 10 Nov 2011. Archived 18 May 2022 at the Wayback Machine
- ↑ "Analgesic Nephropathy. Chronic kidney disease information. Patient | Patient". Patient. Archived from the original on 2016-04-04. Retrieved 2015-10-15. Archived 2016-04-04 at the Wayback Machine
- ↑ Greenberg, Arthur; Cheung, Alfred K. (2005-01-01). Primer on Kidney Diseases. Elsevier Health Sciences. p. 387. ISBN 978-1416023128. Archived from the original on 2022-05-18. Retrieved 2022-01-30.
- ↑ Powell, Christopher (Jan 12, 2017). "Papillary Necrosis". Medscape. Archived from the original on December 14, 2019. Retrieved January 30, 2022. Archived December 14, 2019, at the Wayback Machine
- ↑ Wein, Alan J.; Kavoussi, Louis R.; Novick, Andrew C.; Partin, Alan W.; Peters, Craig A. (2011-09-28). Campbell-Walsh Urology. Elsevier Health Sciences. p. 269. ISBN 978-1455722983. Archived from the original on 2019-12-17. Retrieved 2022-01-30.
- ↑ Kim, Seung Hyup (2011-11-19). Radiology Illustrated: Uroradiology. Springer Science & Business Media. p. 472. ISBN 9783642053221. Archived from the original on 2022-05-18. Retrieved 2022-01-30.
- ↑ "Papillary Necrosis Workup: Laboratory Studies, Imaging Studies, Diagnostic Procedures". emedicine.medscape.com. Archived from the original on 2019-04-14. Retrieved 2015-10-15. Archived 2019-04-14 at the Wayback Machine
- ↑ Schrier, Robert W. (2007-01-01). Diseases of the Kidney and Urinary Tract. Lippincott Williams & Wilkins. p. 2008. ISBN 9780781793070. Archived from the original on 2016-05-29. Retrieved 2022-01-30.
- ↑ Schlossberg, David (2015-04-23). Clinical Infectious Disease. Cambridge University Press. p. 438. ISBN 9781107038912. Archived from the original on 2016-05-17. Retrieved 2022-01-30.
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. Archived from the original on 2020-08-19. Retrieved 2022-01-30.
- 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. doi:10.1177/104063871002200328. ISSN 1040-6387. PMID 20453233.
External links
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