Renal papillary necrosis is ischemic, coagulative necrosis of the renal medullary pyramids and papillae and is a feature of various conditions.
Epidemiology
Etiology
- Often multifactorial
- Sickle cell disease and sickle cell trait
- Acute pyelonephritis
- Obstruction of the urinary tract
- Tuberculosis
- Cirrhosis of the liver
- NSAIDs (due to inhibition of prostaglandin-mediated vasodilation in the vasa recta)
- Diabetes mellitus
Pathophysiology
Usually bilateral
Clinical features
- Flank pain, colicky pain
- Hematuria (microscopic or macroscopic)
- Proteinuria
Acute tubular necrosis vs Renal papillary necrosis
- ATN: Oliguria
- Causes: ischemic or toxic
- RPN: Flank pain, hematuria
- Causes: sickle cell disease, NSAIDs
Diagnostics
Treatment
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