Overview
Renal papillary necrosis involves the death of renal papillae, often leading to complications such as ureteral obstruction or intrarenal aneurysms, frequently seen in patients with underlying conditions like diabetes 12.Diagnosis
Imaging studies (e.g., ultrasound, CT urography) to identify characteristic findings like sloughed papillae or aneurysms 12.
Urinalysis may show hematuria or pyuria 1.
Renal function tests to assess for associated impairment 1.Management
First-line treatments:
- Ureteroscopy for removal of obstructive sloughed papillary bodies 1.
- Percutaneous embolic occlusion for controlling bleeding intrarenal aneurysms 2.
Adjunctive treatments:
- Management of underlying conditions (e.g., diabetes control) 2.
- Supportive care including pain management and hydration 1.Special Populations
Diabetes: Increased risk and specific complications like bleeding aneurysms managed with embolization 2.
No specific recommendations for pregnancy, pediatrics, or elderly populations based on provided abstracts.Key Recommendations
Utilize ureteroscopy for the removal of obstructive sloughed papillary bodies in cases of ureteral obstruction due to papillary necrosis (Evidence: Weak) 1.
Employ super-selective embolic occlusion for managing bleeding intrarenal aneurysms secondary to papillary necrosis (Evidence: Weak) 2.
Control underlying systemic conditions, particularly diabetes, to mitigate complications (Evidence: Expert opinion) 2.References
1 Salo JO, Talja M, Lehtonen T. Ureteroscopy in the treatment of ureteral obstruction caused by papillary necrosis. European urology 1987. link
2 Mathieu J, Schulman CC, Struyven J. Percutaneous embolic occlusion of an acquired bleeding intrarenal aneurysm. European urology 1978. link