A patient with renal papillary necrosis may present with a number of clinical and laboratory findings. A high index of suspicion in a patient with one or more risk factors may be needed to make the diagnosis.
The course may be acute or chronic. The patient may be totally asymptomatic or may follow a fulminant course or follow any course in-between.
Clinical findings:
(1) acute ureteral colic
(2) lumbar or flank pain
(3) gross hematuria
(4) dysuria
(5) fever and chills
(6) oliguria and renal failure are uncommon. This may occur in patients with underlying kidney disease (diabetes, amyloidosis, other) or if the disease is bilateral and extensive.
Laboratory findings:
(1) fragments of necrotic papillae in the urine
(2) proteinuria
(3) gross or microscopic hematuria
(4) modest azotemia (elevation BUN)
(5) leukocytosis
(6) polyuria and nocturia if unable to maximally concentrate the urine secondary to medullary involvement
(7) pyuria
(8) bacteruria with positive urine culture
Differential diagnosis:
(1) nephrolithiasis (a necrotic papilla that has calcified may form a renal stone)
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