(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
either of two bean-shaped excretory organs that filter wastes (especially urea) from the blood and excrete them and water in urine; "urine passes out of the kidney through ureters to the bladder"
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
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]
Contents
1Signs and symptoms
2Causes
3Pathophysiology
4Diagnosis
5Treatment
6References
7Further reading
8External links
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 The risk is higher for phenacetin (which was withdrawn from market in the United States) and paracetamol (acetaminophen) compared to aspirin and other NSAIDs.[medical citation needed]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 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
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
^ abcdef"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.
^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.CS1 maint: extra punctuation (link)
^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.
^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.
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.
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.
Journal of toxicologic pathology 22(2), 125-131, 2009-06-01
… On PNDs 8 and 12, slight dilatation of the collecting ducts was frequently observed in the medulla and slight papillarynecrosis was also noted in some cases. …
Journal of occupational health 47(3), 249-260, 2005-05-00
… Liver necrosis and increased serum levels of AST and ALT were observed in the exposed mice, whereas these changes, which indicate hepatocellular death, did not occur in any of the exposed rats. … Papillary mineralization in the renal pelvis and increased serum levels of BUN and creatinine were noted. …
Research and Development Department Hoechst Schering AgrEvo K.K.
日本農薬学会誌 20(2), 229-237, 1995-05-20
… Histopathology showed the kidney to be the main target organ in all three species. … The principal findings in the kidney, found following subchronic exposure in the rat and following subchronic/chronic exposure in the mouse and dog were papillarynecrosis and dilatation and/or degeneration of the proximal tubules (and collecting ducts in rats). …