​Renal Papillary Necrosis

Renal papillary necrosis is a kidney disorder in which a section or the entire renal papillae die. The renal papillae are the areas of kidneys where the openings of the collecting ducts, that transport the urine to the ureter, enter the kidney; while necrosis means tissue death. Due to this disorder, the kidneys are unable to concentrate the urine. It is mostly caused along with analgesic nephropathy in which damage to the kidneys is caused by long-term use of certain medications, especially over-the-counter pain relievers. Other causes leading to renal papillary necrosis include:

  • Diabetic nephropathy in which damage to kidneys occur due to diabetes

  • Kidney transplant rejection

  • Kidney infection

  • Sickle cell anaemia in which the red blood cells are crescent shaped. It is a common cause of renal papillary necrosis in children

  • Obstruction of urinary tract

Symptoms due to renal papillary necrosis include:

  • Back pain

  • Cloudy appearance of the urine

  • Blood in urine

  • Dead tissue pieces in the urine that may be sloughed off

  • Fever and chills

  • Pain during urination

  • Frequent urination

  • Urinary incontinence (inability to stop the urine from leaking out of the urethra)

  • Large amount of urine                         ​

Consult one of our paediatric nephrologists  from the Children's Hospital Service Line at The Aga Khan University Hospital the only internationally accredited hospital in Pakistan, if you notice any of the above mentioned symptoms, in your child, that are persistent.                         ​
Your time with your doctor maybe limited, so make sure to prepare for your visit beforehand. Here are some tips to help get you started.                         ​

Your doctor may begin the diagnosis by examining your child physically; the abdominal side above the affected kidney my feel tender. The doctor may inquire about your child’s medical history to determine if they had urinary tract infection. For further information regarding the underlying cause of the symptoms, the doctor may request the following tests:

  • Complete blood count (CBC): One or more parameters related to red blood cells, white blood cells and platelets might be affected in this condition, giving a clue towards etiology and further diagnostic approach. Therefore, it is an ancillary test in the diagnostic workup of this disease.​

  • Urinalysis to determine the presence of infection or dead tissue in urine. You may be asked to collect your child’s urine samples over the period of twenty-four hours for an accurate result

  • IVP (Intravenous pyelogram) in which an iodine-based dye will be injected in your child’s vein in the arm. A series of images obtained using X-ray may reveal how the kidneys remove the dye and how it collects in your urine. This is done to identify any blockage or tissue in the renal pelvis or ureters.

​​Disclaimer: Kindly consult your physician before getting the above-mentioned tests.

Unlike other diseases of the kidneys, renal papillary necrosis rarely results in kidney failure. The treatment usually revolves around alleviating the causes of this disorder. The competent doctors at the Children's Hospital Services at The Aga Khan University Hospital will guide you about the best course of treatment for your child. 

Treatment options include:

  • Medications to treat any infection

  • Stenting, to rectify urethral obstruction, in which a stent (a tube or a device) is placed in the duct to create a passage across the blockage

  • Discontinuation of the medications causing analgesic nephropathy                         ​

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the ‘Important Numbers’ section on the website homepage.

The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments’ costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the ‘Important Numbers’ section on the website homepage.                         ​

Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the ‘Important Numbers’ section on the website homepage.                         ​
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The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.