Renal papillary necrosis
| Renal papillary necrosis | |
|---|---|
| File:Illu kidney2.jpg
Frontal section through the kidney
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| Classification and external resources | |
| Specialty | Lua error in Module:Wikidata at line 446: attempt to index field 'wikibase' (a nil value). |
| ICD-10 | N17.2 |
| ICD-9-CM | 584.7 |
| DiseasesDB | 9572 |
| MedlinePlus | 000488 |
| eMedicine | med/2839 radio/523 |
| Patient UK | Renal papillary necrosis |
| MeSH | D007681 |
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
Signs and Symptoms
Symptoms (and signs) consistent with renal papillary necrosis are:[1]
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Causes
In terms of cause, most 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 damage is cumulative and most patients of renal papillary necrosis would have ingested at least 2 kg of analgesics in the past. The risk is higher for phenacetin (which was withdrawn from market in the United States) and paracetamol (acetaminophen) compared to aspirin and other NSAIDs.[medical citation needed]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
The pathophysiology of this condition can be due to analgesic nephropathy, which in turn is a result of long-term use of aspirin.[5] It is a sequence of vascular occlusion, vasospasm, then infection and finally obstruction which leads to RPN.[6]
Diagnosis
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.[7] In terms of imaging this condition can be identified by retrograde pyelography (RGP).[8] The diagnosis of renal papillary necrosis is therefore done via:[9]
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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.[10] Control of infection is important, thus antimicrobial treatment is begun, so as to avert surgery (should the infection not respond).[11]
References
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