Renal papillary necrosis

n d v a l lA necrotic lesion of the renal papillae known as papillitis necroticans, necrotizing renal papillitis or renal papillary necrosis sometimes occurs in infection of the urinary tract (15, 23, 31).Three clinically distinct forms may be recognized: an acute fulminating process, in which death ensues in a few days or weeks, a subacute course extending over several months (26), and a chronic condition that may last several years, with remissions and exacerbations (6, 7).The disease was formerly regarded as rare and the outcome as generally fatal (15), but in recent years treatment with antibiotics and resection or nephrectomy has often enabled the course of the disease to be changed, with the result that the number of chronic cases reported has risen (1, 14).There have been occasional instances where treatment has been said to result in complete recovery (10, 30).I n acute cases, a diagnosis of renal papillary necrosis is usually not made until autopsy but in others the diagnosis can be made ante-mortem through passed papilla fragments or radiologic examination (12, 26, 36).It has hitherto been considered difficult to make a diagnosis solely from a radiologic examination (6, 14).