SynopsisCodesDifferential Diagnosis & PitfallsBest TestsDrug Reaction DataReferences
Renal papillary necrosis
Other Resources UpToDate PubMed

Renal papillary necrosis

Contributors: Christine Osborne MD, Catherine Moore MD
Other Resources UpToDate PubMed


Characterized by coagulative necrosis of the renal medullary pyramids and papillae as a sequela of ischemic and toxic processes on the kidney. In general, occurs in older individuals, typically those older than 60 years, with the exception of pediatric patients with sickle cell disease or hypoxemia.

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

Differential Diagnosis & Pitfalls

Acute onset of symptoms:
  • Urinary tract infection
  • Renal vein thrombosis
  • Urinary bladder calculus
  • Retroperitoneal fibrosis
Papillary necrosis as an imaging finding:
  • Chronic Pyelonephritis
  • Sickle cell disease
  • Diabetes mellitus (Diabetes mellitus type 1, Diabetes mellitus type 2)
  • Renal tuberculosis

Best Tests

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Updated:06/19/2016
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Renal papillary necrosis
A medical illustration showing key findings of Renal papillary necrosis : Chills, Fever, Flank pain, Diffuse abdominal pain, Hematuria
Copyright © 2024 VisualDx®. All rights reserved.