kidney papillary necrosis

腎乳頭壊死

WordNet

1. (botany) a tiny outgrowth on the surface of a petal or leaf
2. a small nipple-shaped protuberance concerned with taste, touch, or smell; "the papillae of the tongue"
3. a small projection of tissue at the base of a hair or tooth or feather
4. 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"
5. the localized death of living cells (as from infection or the interruption of blood supply) (同)mortification, gangrene, sphacelus
6. of or relating to or resembling papilla (同)papillose

PrepTutorEJDIC

1. 乳頭;(毛根・歯根などにある)微小乳頭状突起物
2. 腎臓;(食品としての)羊(豚など)の腎臓 / 《文》気質,性質,たち(nature)
3. 壊疽(えそ)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2019/10/03 08:31:33」(JST)

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[Wiki en表示]

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

Renal papillary necrosis is a form of nephropathy involving the necrosis of the renal papilla. Lesions that characterize renal papillary necrosis come from an impairment of the blood supply and from subsequent ischemic necrosis that is diffuse.

Signs and symptoms

Symptoms (and signs) consistent with renal papillary necrosis are:

• 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. Often, a patient with renal papillary necrosis will have numerous conditions acting synergistically to bring about the disease.

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 The risk is higher for phenacetin (which was withdrawn from market in the United States) and paracetamol (acetaminophen) compared to aspirin and other NSAIDs.

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). Papillary necrosis is more likely to develop when multiple of these underlying factors are present. 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.

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. In terms of imaging this condition can be identified by retrograde pyelography (RGP). The diagnosis of renal papillary necrosis is therefore done via:

• 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. Control of infection is important, thus antimicrobial treatment is begun, so as to avert surgery (should the infection not respond).

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.

External links

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

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. 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
• 4. 成人における血尿の原因および評価 etiology and evaluation of hematuria in adults
• 5. 非ステロイド性抗炎症剤（NSAIDs）：急性腎障害（急性腎不全） nsaids acute kidney injury acute renal failure

English Journal

• Expression and activity of angiotensin-regulating enzymes is associated with prognostic outcome in clear cell renal cell carcinoma patients.

• Errarte P1,2,3, Beitia M1,2,3, Perez I1,2,3, Manterola L4, Lawrie CH4,5,6, Solano-Iturri JD7, Calvete-Candenas J7,8, Unda M9, López JI3,10, Larrinaga G1,2,3.
• PloS one.PLoS One.2017 Aug 15;12(8):e0181711. doi: 10.1371/journal.pone.0181711. eCollection 2017.
• PMID 28809959

• Prognostic significance of extensive necrosis in renal cell carcinoma.

• Collins J1, Epstein JI2.
• Human pathology.Hum Pathol.2017 Aug;66:108-114. doi: 10.1016/j.humpath.2017.06.010. Epub 2017 Jun 29.
• PMID 28669641

• Imaging features of papillary renal cell carcinoma with cystic change-dominant appearance in the era of the 2016 WHO classification.

• Honda Y1, Goto K2, Nakamura Y3, Terada H3, Sentani K4, Yasui W4, Sekino Y2,4, Hayashi T2, Teishima J2, Matsubara A2, Fuji T3, Kaichi Y3, Higaki T3, Baba Y3, Iida M3, Awai K3.
• Abdominal radiology (New York).Abdom Radiol (NY).2017 Jul;42(7):1850-1856. doi: 10.1007/s00261-017-1189-1.
• PMID 28534069

Japanese Journal

• Renal Tubular Cyst Formation in Newborn Rats Treated with p-Cumylphenol

• Nakazawa Tomomi,Kasahara Kenichiro,Ikezaki Shinichiro [他],YAMAGUCHI Yuko,EDAMOTO Hiroshi,NISHIMURA Nobuo,YAHATA Megumi,TAMURA Kazutoshi,KAMATA Eiichi,EMA Makoto,HASEGAWA Ryuichi
• 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 papillary necrosis was also noted in some cases. …
• NAID 10030977996

• Thirteen-week Inhalation Toxicity of ρ-Dichlorobenzene in Mice and Rats

• Aiso Shigetoshi,Arito Heihachiro,Nishizawa Tomoshi [他],NAGANO Kasuke,YAMAMOTO Seigo,MATSUSHIMA Taijiro
• 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. …
• NAID 110003723272

• ベンフレセートの毒性試験の概要

• 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 papillary necrosis and dilatation and/or degeneration of the proximal tubules (and collecting ducts in rats). …
• NAID 110001712814

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★リンクテーブル★

リンク元	「腎乳頭壊死」
関連記事	「papillary」「papilla」「kidney」

「腎乳頭壊死」

　　[★]

英

renal papillary necrosis、kidney papillary necrosis

同

腎髄質壊死 renal medullary necrosis

関

急性腎乳頭壊死

病因

• 糖尿病
• 腎盂腎炎
• 鎮痛剤

「papillary」

　　[★]

• adj.

• 乳頭の、乳頭部の

関

nipple、papilla、papillae

　

「papilla」

　　[★]

• n.

• 乳頭

　 　 　 　

「kidney」

　　[★] 腎臓

同

KUB