6- PAPILLARY NECROSIS

• Necrosis of the renal papilla


  Due to impairment of the blood supply and subsequent diffuse ischemic necrosis
• Causes of necrosis of the renal papilla


  • DM
  • Cirrhosis
  • Sickle cell
  • Urinary obstruction
  • Chronic pyelonephritis
  • Ingestion of acetaminophens or NSAIDs
• Urinalysis shows no WBCs or signs of UTI, but may show necrotic materials
• Diagnosis


  Spiral CT to show bumpy contour of interior where papillae were lost
• Treatment


  1. Stop the offending drug

  2. Avoid excessive use in patients with risk factors