Renal papillary necrosis
Conditions that predispose to the development of renal papillary necrosis include pyelonephritis, urinary tract obstruction, sickle cell hemoglobanopathies including sickle cell trait, tuberculosis (TB), liver cirrhosis, overuse of analgesic agents (especially NSAIDs), renal transplant rejection, radiation to the kidney, type 2 diabetes mellitus, and systemic vasculitis. In many cases, patients who develop renal papillary necrosis have more than 2 of these risk factors.
Presentation is variable, ranging from acute progressive papillary necrosis characterized by the acute onset of symptoms with fever, chills, flank pain with oliguria, and possible progression to renal failure to chronic papillary necrosis leading to progressive renal insufficiency. Patients present with an inability to concentrate their urine. Obstructive symptoms of flank pain and colic may develop due to sloughed papillary cells, and pyelonephritis may develop in necrotic areas of renal papillae.
N17.2 – Acute kidney failure with medullary necrosis
90241004 – Papillary necrosis