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Renal papillary necrosis

Necrosis - renal papillae; Renal medullary necrosis

Renal papillary necrosis is a disorder of the kidneys in which all or part 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.

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Kidney anatomy
Kidney - blood and urine flow

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Causes

Renal papillary necrosis often occurs with analgesic nephropathy. This is damage to one or both kidneys caused by overexposure to pain medicines. But, other conditions can also cause renal papillary necrosis, including:

Symptoms

Symptoms of renal papillary necrosis may include:

Other symptoms that may occur with this disease:

Exams and Tests

The area over the affected kidney (in the flank) may feel tender during an exam. There may be a history of urinary tract infections. There may be signs of blocked urine flow or kidney failure.

Tests that may be done include:

Treatment

There is no specific treatment for renal papillary necrosis. Treatment depends on the cause. For example, if analgesic nephropathy is the cause, your doctor will recommend that you stop using the medicine that is causing it. This may allow the kidney to heal over time.

Outlook (Prognosis)

How well a person does, depends on what is causing the condition. If the cause can be controlled, the condition may go away on its own. Sometimes, people with this condition develop kidney failure and will need dialysis or a kidney transplant.

Possible Complications

Health problems that may result from renal papillary necrosis include:

When to Contact a Medical Professional

Call for an appointment with your health care provider if:

Prevention

Controlling diabetes or sickle cell anemia may reduce your risk. To prevent renal papillary necrosis from analgesic nephropathy, follow your provider's instructions when using medicines, including over-the-counter pain relievers. Do not take more than the recommended dose without asking your provider.

Related Information

Renal
Necrosis
Urinary tract infection - adults
Analgesic nephropathy
Diabetes and kidney disease
Sickle cell disease
Urinary tract infection - children
Acute kidney failure
Chronic kidney disease
Metabolic acidosis
High potassium level
Hypovolemic shock

References

Bushinsky DA, Monk RD. Nephrolithiasis and nephrocalcinosis. In: Johnson RJ, Feehally J, Floege J, eds. Comprehensive Clinical Nephrology. 5th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 59.

Landry DW, Bazari H. Approach to the patient with renal disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 114.

Schaeffer AJ, Matulewicz RS, Klumpp DJ. Infections of the urinary tract. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 12.

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Review Date: 8/1/2017  

Reviewed By: Walead Latif, MD, Nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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