Renal papillary necrosis is a disorder of the kidneys in which all or part renal papillae die. The renal papillae is the area where the openings of the collecting ducts enter the kidney.

Renal papillary necrosis is most commonly associated with analgesic nephropathy. However, a number of conditions can cause this condition, including:

• Diabetic nephropathy
• Kidney infection
• Kidney transplant rejection
• Urinary tract obstruction
• Sickle cell anemia

Sickle cell anemia is a common cause of renal papillary necrosis in children.

Necrosis (tissue death) of the renal papillae may make the kidney unable to concentrate the urine. Symptoms may include:

• Back pain or flank pain
• Bloody urine
• Cloudy urine
• Dark, rust-colored, or brown urine
• Tissue in the urine

Additional symptoms that may be associated with this disease:

• Chills
• Incontinence
• Increased urinary frequency or urgency
• Painful urination
• Passing large amounts of urine
• Urinating frequently at night
• Urinary hesitancy

An examination may reveal tenderness when touching the body over the affected kidney. There may be a history of chronic or recurrent urinary tract infections. There may be signs of obstructive uropathy or renal failure.

A urinalysis may show dead tissue in the urine.

An IVP may show obstruction or tissue in the renal pelvis or ureter.