eMedicine Specialties > Urology > Infections and Related Inflammatory Conditions

Papillary Necrosis: Multimedia

Author: Jeffrey M Donohoe, MD, Assistant Professor of Pediatric Urology, Department of Surgery, Division of Urology, Medical College of Georgia
Coauthor(s): Jack H Mydlo, MD, Chief, Department of Urology, Woodhull Hospital; Chair and Professor, Department of Urology, Temple University School of Medicine
Contributor Information and Disclosures

Updated: Jan 9, 2008

Multimedia

In this figure, the multifactorial nature of rena...
(Enlarge Image)
Media file 1: In this figure, the multifactorial nature of renal papillary necrosis is represented by 5 of the disease's most frequently associated conditions: infection, obstruction, diabetes mellitus, analgesic abuse, and sickle cell disease. Each circle represents a condition. Note how the conditions overlap; the red areas show the coexistence of 2 conditions, and the black areas represent 3 coexistent conditions. Multiple conditions exhibit synergism and, therefore, worsen both the severity of the disease and the prognosis.
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In this figure, the multifactorial nature of rena...

In this figure, the multifactorial nature of renal papillary necrosis is represented by 5 of the disease's most frequently associated conditions: infection, obstruction, diabetes mellitus, analgesic abuse, and sickle cell disease. Each circle represents a condition. Note how the conditions overlap; the red areas show the coexistence of 2 conditions, and the black areas represent 3 coexistent conditions. Multiple conditions exhibit synergism and, therefore, worsen both the severity of the disease and the prognosis.

Cystoscopic photograph of sloughed papilla extrud...
(Enlarge Image)
Media file 2: Cystoscopic photograph of sloughed papilla extruding from the ureteral orifice. The patient was a 51-year-old man with poorly controlled diabetes and a history of microhematuria and an acute onset of severe left flank pain. Findings of upper tract imaging with a renal ultrasonography and intravenous pyelography were remarkable only for mixed heterogeneity consistent with medical renal disease. Urine cytology results were negative, and culture showed no growth. In-office flexible cystoscopy revealed the mass extruding from the left ureteral orifice, which required sedation and rigid cystoscopy to extract. Gross examination yielded a tan, friable, irregular, wedge-shaped soft tissue mass 1.7 cm X 1.6 cm X 1.5 cm. Bilateral retrograde pyelography revealed a clubbed left upper pole calyx and no other filling defects. The pathology was necrotic epithelial tissue.
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Cystoscopic photograph of sloughed papilla extrud...

Cystoscopic photograph of sloughed papilla extruding from the ureteral orifice. The patient was a 51-year-old man with poorly controlled diabetes and a history of microhematuria and an acute onset of severe left flank pain. Findings of upper tract imaging with a renal ultrasonography and intravenous pyelography were remarkable only for mixed heterogeneity consistent with medical renal disease. Urine cytology results were negative, and culture showed no growth. In-office flexible cystoscopy revealed the mass extruding from the left ureteral orifice, which required sedation and rigid cystoscopy to extract. Gross examination yielded a tan, friable, irregular, wedge-shaped soft tissue mass 1.7 cm X 1.6 cm X 1.5 cm. Bilateral retrograde pyelography revealed a clubbed left upper pole calyx and no other filling defects. The pathology was necrotic epithelial tissue.

More on Papillary Necrosis

Overview: Papillary Necrosis
Workup: Papillary Necrosis
Treatment: Papillary Necrosis
Follow-up: Papillary Necrosis
Multimedia: Papillary Necrosis
References
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References

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Further Reading

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Keywords

papillary necrosis, renal papillary necrosis, RPN, renal medullary necrosis, medullary necrosis, interstitial nephritis, sloughed papilla, urinary obstruction, ureteropelvic junction obstruction, UPJ obstruction, ureteral obstruction, ureterovesical junction obstruction, analgesic nephropathy, analgesic-induced nephropathy, analgesic abuse, pyelonephritis, tubulointerstitial nephritis, urinary tract infection, UTI, sickle cell hemoglobinopathy, sickle cell trait, sickle cell disease, tuberculosis, cirrhosis of the liver, cirrhosis, chronic alcoholism, renal transplant rejection, diabetes mellitus, diabetes complications, systemic vasculitis, phenacetin

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Contributor Information and Disclosures

Author

Jeffrey M Donohoe, MD, Assistant Professor of Pediatric Urology, Department of Surgery, Division of Urology, Medical College of Georgia
Jeffrey M Donohoe, MD is a member of the following medical societies: American Academy of Pediatrics and American Urological Association
Disclosure: Nothing to disclose.

Coauthor(s)

Jack H Mydlo, MD, Chief, Department of Urology, Woodhull Hospital; Chair and Professor, Department of Urology, Temple University School of Medicine
Jack H Mydlo, MD is a member of the following medical societies: American College of Surgeons, American Urological Association, International College of Surgeons US Section, and Society of University Urologists
Disclosure: Nothing to disclose.

Medical Editor

Gamal Mostafa Ghoniem, MD, FACS, Fellowship Program Director, Clinical Professor of Surgery, Head, Section of Voiding Dysfunction, Female Urology and Reconstruction, Cleveland Clinic Florida
Gamal Mostafa Ghoniem, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Society for Urology and Engineering, and Society of University Urologists
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf, Jr, MD, FACS, David A Bloom Professor of Urology, Director, Division of Minimally Invasive Urology, Department of Urology, University of Michigan Medical Center
J Stuart Wolf, Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Bradley Fields Schwartz, DO, FACS, Associate Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Nothing to disclose.

 
 
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