Due to impairment of the blood supply and from subsequent ischemic necrosis that is diffuse.
- Suspect in Diabetes/Sickle cell and AKI
- Papillae lie in hypertonic region in medulla
- Susceptible to ischaemic damage
- Necrosed papillae cause renal obstruction
- Pyelonephritis - an infection in the kidneys
- Obstruction - a blockage in the blood vessels leading to the kidneys
- Sickle cell anaemia, TB, Cirrhosis
- Analgesic abuse, Renal vein thrombosis -
- Diabetes, Systemic vasculitis
- Asymptomatic in some
- Renal Colic, Back pain, cloudy/bloody urine, tissue in urine
- U&E: AKI / CKD may be seen
- FBC, U&E, ESR, Ca, P, Glucose, Myeloma etc
- Urine: may be normal or haematuria and sterile pyuria. Mild proteinuria
- CT urogram or IVP shows a necrotic cavity in central or peripheral papillae. Entire papillae can slough off causing obstruction.
- Generally supportive.
- Relieve obstruction and remove or treat cause