Repeated Bouts of Renal Papillary Necrosis Diagnosed by Examination of Voided Tissue

ACUTE necrosis of the renal papillae occurs in diabetic patients with acute pyelonephritis and in nondiabetic patients with urinary tract obstruction.1In a few patients, papillary necrosis has been encountered in the absence of diabetes and urinary tract obstruction.2However, acute pyelonephritis is a consistent finding. In four instances, the occurrence of papillary necrosis has been recognized during life by histological examination of tissue passed in the urine.3Alken,4in Germany (1938), reported a case of papillary necrosis in a 50-year-old woman with painless hematuria. There was decreased function of the left kidney; Escherichia coli was found in the urine, and pyelography demonstrated a defect in the left upper calyx. Six months later, she returned with renal colic on the left. A portion of tissue was passed in the urine, and the diagnosis was made histologically. Recently, Knutsen and co-workers observed a patient for whom the diagnosis was established by