Renal papillary necrosis

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Renal papillary necrosis
Illu kidney2.jpg
Frontal section through the kidney
Classification and external resources
Specialty urology
ICD-10 N17.2
ICD-9-CM 584.7
DiseasesDB 9572
MedlinePlus 000488
eMedicine med/2839 radio/523
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]

Signs and Symptoms[edit]

Symptoms (and signs) consistent with renal papillary necrosis are:[1]

Causes[edit]

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 The risk is higher for phenacetin (which was withdrawn from market in the United States) and paracetamol (acetaminophen) compared to aspirin and other NSAIDs.[medical citation needed]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

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[edit]

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.[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]

Treatment[edit]

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[edit]

  1. ^ a b "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. Retrieved 15 October 2015. 
  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 1416023127. 
  7. ^ 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 1455722987. 
  8. ^ Kim, Seung Hyup (2011-11-19). Radiology Illustrated: Uroradiology. Springer Science & Business Media. p. 472. ISBN 9783642053221. 
  9. ^ "Papillary Necrosis Workup: Laboratory Studies, Imaging Studies, Diagnostic Procedures". emedicine.medscape.com. Retrieved 2015-10-15. 
  10. ^ Schrier, Robert W. (2007-01-01). Diseases of the Kidney and Urinary Tract. Lippincott Williams & Wilkins. p. 2008. ISBN 9780781793070. 
  11. ^ Schlossberg, David (2015-04-23). Clinical Infectious Disease. Cambridge University Press. p. 438. ISBN 9781107038912. 

Further reading[edit]