Renal papillary necrosis

Question 1

renal papillary necrosis (RPN) is

Answer 1

coagulative necrosis of the renal medullary pyramids and papillae due to ischemia

Question 2

presentation and progression of renal papillary necrosis (RPN)

Answer 2

depends on number of affected papillae and degree of vascular impairment

can be chronic, protracted or relapsing with acute rapidly progressive form

see fever, chills, flank pain and abdominal pain, hematuria, acute renal failure with oliguria,

anuria develops, dialysis may be required

Question 3

if pt has diabetes or pt with chronic renal obstruction and pyelonephritis has a sudden decrease in renal function need to consider

Answer 3

renal papillary necrosis (RPN) flank pain and renal colic result from acute ureteral obstruction as papillae slough off

Question 4

what is seen on labs with renal papillary necrosis (RPN)

Answer 4

hematuria, elevated Cr see flank pain

Question 5

what causes renal papillary necrosis (RPN)

Answer 5

analgesic abuse with NSAIDS or Tylenol or both are common causes

other causes are:

DM2

sickle cell dx

pyelonephritis (in kids esp)

obstruction

renal vein thrombosis

renal TB cirrhosis

Question 6

what is seen on imaging with renal papillary necrosis (RPN)

Answer 6

see necrotic cavity filled centrally or peripherally in the papillae

Question 7

contrast enhanced CT of renal papillary necrosis (RPN)

Answer 7

excretory phase can depict necrosis see ball on a tee or forniceal excavation or lobster claw or signet ring or sloughed papillae with clubbed calyx. also seen on IV pyelogram