Definition

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.

Alternative Names

Necrosis - renal papillae; Renal medullary necrosis

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:

• Diabetic nephropathy
• Kidney infection (pyelonephritis)
• Kidney transplant rejection
• Sickle cell anemia, a common cause of renal papillary necrosis in children
• Urinary tract blockage

Symptoms

Symptoms of renal papillary necrosis may include:

• Back pain or flank pain
• Bloody, cloudy, or dark urine
• Tissue pieces in the urine

Other symptoms that may occur with this disease:

• Fever and chills
• Painful urination
• Needing to urinate more often than usual (frequent urination) or a sudden, strong urge to urinate (urgency)
• Difficulty starting or maintaining a urine stream (urinary hesitancy)
• Urinary incontinence
• Urinating large amounts
• Urinating often at night

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:

• Urine test
• Blood tests
• Ultrasound, CT, or other imaging tests of the kidneys

Treatment

There is no specific treatment for renal papillary necrosis. Treatment depends on the cause. For example, if analgesic nephropathy is the cause, your health care provider 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:

• Kidney infection
• Kidney stones
• Kidney cancer, especially in people who take a lot of pain medicines

When to Contact a Medical Professional

Contact your provider for an appointment if:

• You have bloody urine
• You develop other symptoms of renal papillary necrosis, especially after taking over-the-counter pain medicines

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.

References

Chen W, Bushinsky DA. Nephrolithiasis and nephrocalcinosis. In: Feehally J, Floege J, Tonelli M, Johnson RJ, eds. Comprehensive Clinical Nephrology. 7th ed. Philadelphia, PA: Elsevier; 2024:chap 60.

Cooper KL, Badalato GM, Rutman MP. Infections of the urinary tract. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 55.

Gharavi AG,Landry DW. Approach to the patient with renal disease. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 100.