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    Renal papillary necrosis

    Necrosis - renal papillae; Renal medullary necrosis

    Renal papillary necrosis is a disorder of the kidneys in which all or part of the renal papillae die. The renal papillae are the areas where the openings of the collecting ducts enter the kidney and where urine flows into the ureters.

    Causes

    Renal papillary necrosis often occurs with analgesic nephropathy. This is damage to one or both kidneys caused by overexposure to pain medicines. But, other conditions can also cause renal papillary necrosis, including:

    Symptoms

    Symptoms of renal papillary necrosis may include:

    Other symptoms that may occur with this disease:

    Exams and Tests

    The area over the affected kidney (in the flank) may feel tender during an exam. There may be a history of urinary tract infections. There may be signs of blocked urine flow or kidney failure.

    Tests that may be done include:

    • Urine test
    • Blood tests including BUN and serum creatinine
    • Ultrasound, CT, or other imaging tests of the kidneys

    Treatment

    There is no specific treatment for renal papillary necrosis. The treatment depends on the cause. For example, if analgesic nephropathy is the cause, your health care provider will recommend that you stop using the medicine that is causing it. This may allow the kidney to heal over time.

    Outlook (Prognosis)

    How well a person does depends on what is causing the condition. If the cause can be controlled, the condition may go away on its own. Sometimes, people with this condition develop kidney failure and will need dialysis or a kidney transplant.

    Possible Complications

    Health problems that may result from renal papillary necrosis include:

    • Kidney infection
    • Kidney stones
    • Kidney cancer, especially in people who take a lot of pain medicines

    When to Contact a Medical Professional

    Contact your provider for an appointment if:

    • You have bloody urine
    • You develop other symptoms of renal papillary necrosis, especially after taking over-the-counter pain medicines

    Prevention

    Controlling diabetes or sickle cell anemia may reduce your risk. To prevent renal papillary necrosis from analgesic nephropathy, follow your provider's instructions when using medicines, including over-the-counter pain relievers. Do not take more than the recommended dose without asking your provider.

    Open References

    References

    Chen W, Bushinsky DA. Nephrolithiasis and nephrocalcinosis. In: Johnson RJ, Floege J, Tonelli M, eds. Comprehensive Clinical Nephrology. 7th ed. Philadelphia, PA: Elsevier; 2024:chap 60.

    Drekonja D, Hooton T. Urinary tract infections in adults. In: Johnson RJ, Floege J, Tonelli M, eds. Comprehensive Clinical Nephrology. 7th ed. Philadelphia, PA: Elsevier; 2024:chap 53.

    Gharavi AG, Landry DW. Approach to the patient with renal disease. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 100.

      • Kidney anatomy

        Kidney anatomy - illustration

        The kidneys are responsible for removing wastes from the body, regulating electrolyte balance and blood pressure, and the stimulation of red blood cell production.

        Kidney anatomy

        illustration

      • Kidney - blood and urine flow

        Kidney - blood and urine flow - illustration

        This is the typical appearance of the blood vessels (vasculature) and urine flow pattern in the kidney. The blood vessels are shown in red and the urine flow pattern in yellow.

        Kidney - blood and urine flow

        illustration

        • Kidney anatomy

          Kidney anatomy - illustration

          The kidneys are responsible for removing wastes from the body, regulating electrolyte balance and blood pressure, and the stimulation of red blood cell production.

          Kidney anatomy

          illustration

        • Kidney - blood and urine flow

          Kidney - blood and urine flow - illustration

          This is the typical appearance of the blood vessels (vasculature) and urine flow pattern in the kidney. The blood vessels are shown in red and the urine flow pattern in yellow.

          Kidney - blood and urine flow

          illustration

        Review Date: 9/2/2025

        Reviewed By: Walead Latif, MD, Nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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