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 The risk is higher for phenacetin (which was withdrawn from market in the United States) and paracetamol (acetaminophen) compared to aspirin and other NSAIDs.[medical citation needed]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 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
^ abcde"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.
^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.
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
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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
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]
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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 the urine flows into ...