Renal papillary necrosis: An update

G. Eknoyan, Wajeh Y Qunibi, R. T. Grissom, S. N. Tuma, J. C. Ayus

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

The clinical and diagnostic features of renal papillary necrosis (RPN) of 27 patients were studied. Diabetes mellitus was the most frequent (56%) condition associated with RPN. Analgesic abuse, sickle hemoglobinopathy and urinary tract obstruction were present in 4 patients each; in 6 of these 12 patients these conditions were present as a coexistent disease with diabetes mellitus. There was evidence of an acute or chronic infection of the urinary tract in 18 patients, as a coexistent condition with another underlying disease that itself can cause RPN in 14 patients and as the only cause of RPN in another 4. Thus, the presence of more than one diagnostic condition which might be implicated in the causation of RPN was present in 15 patients or 55% of the cases in this series. When infection was excluded, six patients or 22% of the cases had two coexisting diseases, each of which has been implicated as a cause of RPN. This observation underlines the multifactorial nature of this entity and might explain why RPN is not encountered more frequently in each of the various primary diseases with which it has been associated. The average age of the patients at the time of diagnosis was 53 years for women and 56 years for men. Only six of the patients were younger than 40 years, and three of these had sickle hemoglobinopathy. The diagnosis of RPN was based on x-ray findings in eight patients, on the histologic examination of papillary tissue in urine in one, and on autopsy findings in the rest. Papillary necrosis was bilateral in three-fourths of the cases. The clinical picture varied. Most of the patients (67%) presented with chills and fever. Flank pain and dysuria were present in 11 patients (41%). As a rule oliguria was rare and progressive uremia was uncommon. In cases diagnosed at post-mortem, the patients had succumbed to infection or to a primary severe extrarenal disorder with the possibility of RPN having been entertained clinically in only half these cases prior to autopsy.

Original languageEnglish (US)
Pages (from-to)55-73
Number of pages19
JournalMedicine
Volume61
Issue number2
StatePublished - 1982
Externally publishedYes

Fingerprint

Necrosis
Kidney
Hemoglobinopathies
Autopsy
Diabetes Mellitus
Oliguria
Flank Pain
Dysuria
Chills
Uremia
Infection
Urinary Tract
Urinary Tract Infections
Causality
Analgesics
Fever
X-Rays
Urine

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Eknoyan, G., Qunibi, W. Y., Grissom, R. T., Tuma, S. N., & Ayus, J. C. (1982). Renal papillary necrosis: An update. Medicine, 61(2), 55-73.

Renal papillary necrosis : An update. / Eknoyan, G.; Qunibi, Wajeh Y; Grissom, R. T.; Tuma, S. N.; Ayus, J. C.

In: Medicine, Vol. 61, No. 2, 1982, p. 55-73.

Research output: Contribution to journalArticle

Eknoyan, G, Qunibi, WY, Grissom, RT, Tuma, SN & Ayus, JC 1982, 'Renal papillary necrosis: An update', Medicine, vol. 61, no. 2, pp. 55-73.
Eknoyan G, Qunibi WY, Grissom RT, Tuma SN, Ayus JC. Renal papillary necrosis: An update. Medicine. 1982;61(2):55-73.
Eknoyan, G. ; Qunibi, Wajeh Y ; Grissom, R. T. ; Tuma, S. N. ; Ayus, J. C. / Renal papillary necrosis : An update. In: Medicine. 1982 ; Vol. 61, No. 2. pp. 55-73.
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