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Renal papillary necrosis

Dr Abhilash Sandhyala and Radswiki et al.

Renal papillary necrosis refers to ischemic necrosis of the renal papillae. Necrosis occurs in the medullary pyramids, also.

Pathology

Papillary necrosis is characterised by necrosis and sloughing of papillary tissue may result in a substantial loss of renal function.

For a list of causes, see: renal papillary necrosis (mnemonic)

Radiographic features

CT / CT IVP

Renal papillary necrosis is visible when contrast material (eg, at IV urography) in the urinary collecting system fills a necrotic cavity located centrally or peripherally in the papillae. Contrast enhanced CT during the excretory phase can depict necrosis as clearly as does IV urography and thus allow accurate diagnosis of the condition ².

CT urography typically demonstrates multiple small collections of contrast material in the papillary regions peripheral to the calyces. The entire papilla may become necrotic. The papillary defects may eventually become peripherally calcified. Sloughed papillae appear as filling defects in the collecting system and ureters ³.