WordNet

(botany) a tiny outgrowth on the surface of a petal or leaf
a small nipple-shaped protuberance concerned with taste, touch, or smell; "the papillae of the tongue"
a small projection of tissue at the base of a hair or tooth or feather
the localized death of living cells (as from infection or the interruption of blood supply) (同)mortification, gangrene, sphacelus
of or relating to or resembling papilla (同)papillose

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乳頭;(毛根・歯根などにある)微小乳頭状突起物
壊疽(えそ)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2019/04/11 17:30:35」(JST)

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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 abuse, 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 The risk is higher for phenacetin (which was withdrawn from market in the United States) and paracetamol (acetaminophen) compared to aspirin and other NSAIDs.^{[medical citation needed]}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 caliper 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

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 renal failure.^[11] Control of infection is important, thus antimicrobial treatment is begun, so as to avert surgery (should the infection not respond).^[12]

References

^ ^a ^b ^c ^d ^e "Renal Papillary Necrosis". Medline. NIH. Retrieved 15 October 2015.
^ 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. doi:10.1148/rg.266065039. PMID 17102053.
^ Kim, Seung Hyup (2011-11-19). Radiology Illustrated: Uroradiology. Springer Science & Business Media. p. 471. ISBN 9783642053221.
^ Powell, Christopher. "Papillary Necrosis". Medscape Reference. Retrieved 10 Nov 2011.
^ "Analgesic Nephropathy. Chronic kidney disease information. Patient | Patient". Patient. Retrieved 2015-10-15.
^ Greenberg, Arthur; Cheung, Alfred K. (2005-01-01). Primer on Kidney Diseases. Elsevier Health Sciences. p. 387. ISBN 978-1416023128.
^ Powell,, Christopher (Jan 12, 2017). "Papillary Necrosis". Medscape.
^ 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.
^ Kim, Seung Hyup (2011-11-19). Radiology Illustrated: Uroradiology. Springer Science & Business Media. p. 472. ISBN 9783642053221.
^ "Papillary Necrosis Workup: Laboratory Studies, Imaging Studies, Diagnostic Procedures". emedicine.medscape.com. Retrieved 2015-10-15.
^ Schrier, Robert W. (2007-01-01). Diseases of the Kidney and Urinary Tract. Lippincott Williams & Wilkins. p. 2008. ISBN 9780781793070.
^ Schlossberg, David (2015-04-23). Clinical Infectious Disease. Cambridge University Press. p. 438. ISBN 9781107038912.

External links

UpToDate Contents

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1. 鎮痛剤性腎症の臨床症状および診断 clinical manifestations and diagnosis of analgesic nephropathy
2. 鎌状赤血球症の腎症状 renal manifestations of sickle cell disease
3. 成人における血尿の原因および評価 etiology and evaluation of hematuria in adults
4. 鎮痛薬に起因する慢性腎臓病（鎮痛薬腎症）の疫学と発症機序 epidemiology and pathogenesis of analgesic related chronic kidney disease
5. 非ステロイド性抗炎症剤（NSAIDs）中毒 nonsteroidal antiinflammatory drug nsaid poisoning

English Journal

Clinicopathologic Analysis of PD-L1 and PD-L2 Expression in Renal Cell Carcinoma: Association with Oncogenic Proteins Status.

Shin SJ1, Jeon YK2, Kim PJ3, Cho YM1, Koh J2, Chung DH2,4, Go H5.
Annals of surgical oncology.Ann Surg Oncol.2015 Oct 13. [Epub ahead of print]
BACKGROUND: Immune checkpoint blockade therapy targeting programmed death (PD)-1 or PD-ligand1 (L1) has shown promising results in renal cell carcinoma (RCC); however, the prognostic implications and clinicopathological features of PD-L1 and PD-L2 expression in RCC remain unclear.METHODS: PD-L1 and
PMID 26464193

Genitourinary manifestations of sickle cell disease.

Gebreselassie S1,2, Simmons MN3, Montague DK4,5,6.
Cleveland Clinic journal of medicine.Cleve Clin J Med.2015 Oct;82(10):679-83. doi: 10.3949/ccjm.82a.14029.
Sickle cell disease is a common genetic disorder characterized by sickling of red blood cells under conditions of reduced oxygen tension. In turn, sickling leads to intravascular hemolysis and vaso-occlusive events with subsequent tissue ischemia-reperfusion injury affecting multiple organs, includi
PMID 26469825

Japanese Journal

左耳介後部に生じた乳頭状汗管囊胞腺癌の1例

佐藤愛,高村直子,猪原康司,大和義幸,磯野伸雄,千葉由幸
Skin Cancer 29(2), 201-205, 2015
57歳，女性。幼少期から左耳介後部に「ホクロ」があり，徐々に増大した。初診時現症では左耳介後部に一部表面湿潤な弾性硬紅色腫瘤を認めた。生検時病理組織所見では高円柱状細胞と立方細胞の2層性で，断頭分泌を認める腫瘍細胞が乳頭状に増殖しており，間質には稠密に形質細胞が浸潤していた。乳頭状汗管囊胞腺腫と診断したが，手術検体の永久標本では好酸性細胞質を持った異型細胞が壊死を伴って充実胞巣状や乳頭腺管状に増殖 …
NAID 130004836602

Prognostic classification of thyroid follicular cell tumors using Ki-67 labeling index: Risk stratification of thyroid follicular cell carcinomas [Review]

Kakudo Kennichi,Wakasa Tomoko,Ohta Yoshio,Yane Katsunari,Ito Yasuhiro,Yamashita Hiroyuki
Endocrine Journal 62(1), 1-12, 2015
… High-grade histological features, such as tumor necrosis, increased mitoses, and nuclear pleomorphism, together with high Ki-67 labeling index (more than 10%), are good indicators of high-risk thyroid carcinoma and suggest a possible risk for anaplastic transformation. … Currently, both the aggressive variant of papillary carcinoma and poorly differentiated carcinoma are aggressively treated by a completion of total thyroidectomy with prophylactic lymph node dissection followed by radioactive iodine treatment. …
NAID 130004770466

Related Pictures

★リンクテーブル★

リンク元	「壊死性乳頭炎」
関連記事	「papillary」「papilla」

「壊死性乳頭炎」

Classification	D ICD-10: N17.2; ICD-9-CM: 584.7; MeSH: D007681; DiseasesDB: 9572;
External resources	MedlinePlus: 000488; eMedicine: med/2839 radio/523;

Renal papillary necrosis
	Frontal section through the kidney
Specialty	Urology, Nephrology
Causes	Diabetic nephropathy, Kidney infection
Diagnostic method	Blood and urine test
Treatment	Depends on cause

　　[★]

英: necrotizing papillitis, papillary necrosis
同: 壊死性腎乳頭炎
関: 腎乳頭

「papillary」

　　[★]

adj.

乳頭の、乳頭部の

関: nipple、papilla、papillae

「papilla」

　　[★]

n.

乳頭

[Med2014-1] "Renal Papillary Necrosis". Medline. NIH. Retrieved 15 October 2015.

[2] 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. doi:10.1148/rg.266065039. PMID 17102053.

[3] Kim, Seung Hyup (2011-11-19). Radiology Illustrated: Uroradiology. Springer Science & Business Media. p. 471. ISBN 9783642053221.

[4] Powell, Christopher. "Papillary Necrosis". Medscape Reference. Retrieved 10 Nov 2011.

[5] "Analgesic Nephropathy. Chronic kidney disease information. Patient | Patient". Patient. Retrieved 2015-10-15.

[6] Greenberg, Arthur; Cheung, Alfred K. (2005-01-01). Primer on Kidney Diseases. Elsevier Health Sciences. p. 387. ISBN 978-1416023128.

[7] Powell,, Christopher (Jan 12, 2017). "Papillary Necrosis". Medscape.

[8] 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.

[9] Kim, Seung Hyup (2011-11-19). Radiology Illustrated: Uroradiology. Springer Science & Business Media. p. 472. ISBN 9783642053221.

[10] "Papillary Necrosis Workup: Laboratory Studies, Imaging Studies, Diagnostic Procedures". emedicine.medscape.com. Retrieved 2015-10-15.

[11] Schrier, Robert W. (2007-01-01). Diseases of the Kidney and Urinary Tract. Lippincott Williams & Wilkins. p. 2008. ISBN 9780781793070.

[12] Schlossberg, David (2015-04-23). Clinical Infectious Disease. Cambridge University Press. p. 438. ISBN 9781107038912.

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案内

案内

papillary necrosis