What is Papillary Necrosis?

Papillary necrosis occurs when the tip of the renal pyramid within the kidneys, known as renal papilla, becomes necrotic. These papillae are responsible for carrying urine from the nephrons into the minor calyces, and then to the bladder. When necrosis takes place, it disrupts this process and can cause complications. Conditions that can lead to papillary necrosis include diabetes, prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs), and urinary tract infections as they can reduce the blood flow or increase pressure within the kidney. Other factors that can increase the risk of papillary necrosis are sickle cell disease, kidney stones and urinary tract obstruction.¹

Symptoms of Papillary Necrosis

Common symptoms of papillary necrosis can include:

• Hematuria - blood in the urine 
• Flank pain 
• Fever 
• Infections 

Diagnosing Papillary Necrosis

Diagnosing papillary necrosis usually involves imaging studies and laboratory tests. These include:

• Ultrasound 
• MRI scans 
• CT scans
• Intravenous pyelography - an imaging tool used to examine the kidneys, ureters and bladders
• Urinalysis 
• Blood tests - can show if there are elevated levels of creatinine or urea in the blood
• Cystoscopy - insertion of a thin tube into the urethra to examine the bladder for any damages

Managing Papillary Necrosis

Managing papillary necrosis involves finding what is causing it, managing the symptoms and preventing further kidney damage from occurring. Management strategies can include:

• NSAID usage - discontinue using these drugs and switch to using safer alternatives
• Diabetes - patients with diabetes should control their blood sugar levels to prevent further kidney damage. Consult with a doctor to see if you need to make any adjustments to medications or lifestyle changes^1,9
• Sickle cell disease - sickle cell anaemia can be managed through blood transfusions, lowering the risk of papillary necrosis
• Infections - treating urinary infections with necessary antibiotics can reduce the risks of developing papillary necrosis
• Nephrectomy - in severe cases, the patient may require surgery. This surgery removes the affected kidney, lowering the risks of serious infections
• Pain management - it is recommended to use alternative pain relief medicines such as non-nephrotoxic medications. Avoiding the usage of NSAIDs is essential to improve kidney health. However, it is often better to speak to a medical professional about the necessary changes that may be required¹¹ 

Prognosis/Long-term outlook

Long-term management of papillary necrosis varies the severity of the condition. If the necrosis is confined and the main cause is managed properly, patients will be able to sustain stable kidney function. However, severe cases may progress into chronic kidney disease (CKD) or end-stage renal failure, which may require kidney transplantations or dialysis. 

FAQs

Is there treatment for papillary necrosis?

There is treatment for papillary necrosis, but it can be managed by effective treatment.¹

What are the complications of papillary necrosis?

In serious cases, it can lead to end-stage kidney failure or chronic kidney disease.¹

Summary 

An effective approach to managing papillary necrosis requires early diagnosis, treating main causes, and monitoring kidney function regularly. This can help to reduce the risks of any further complications. To prevent further kidney damage, patients will be required to change their lifestyle and need to avoid taking nephrotoxic drugs. With these correct measures, people can lead a better quality of life.