Griffin MD, Bergstralh EJ, Larson TS
Renal papillary necrosis: a sixteen-year clinical experience

J Am Soc Nephrol (Aug) 6:248-256 1995

Griffin et al describe the clinical characteristics of 165 cases of renal papillary necrosis encountered at the Mayo Clinic between 1976 and 1992. The etiologies of these cases run the usual gamut of diseases known to cause papillary necrosis including UTI, obstructive nephropathy, analgesic abuse, diabetes mellitus and sickle cell disease with a few surprises such as lupus, Wegeners and renal artery stenosis. The most dramatic findings of the study are the lack of clinical suspicion prior to diagnosis in over 70 percent of the cases. Further, there has been a decline in the diagnosis rate of papillary necrosis over the last 10 years that the authors relate to changes in diagnostic techniques and specifically to a greater reliance in imaging on ultrasound, which has a relatively low sensitivity for papillary necrosis. The negative prognostic impact of the condition in diabetes is well established and further verified by this study. The lack of clinical recognition and the decline in diagnosis rate should inspire nephrologists to greater vigilance particularly when treating diabetic patients with UTI or obstruction. (Mujais)

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ARF etiology : Papillary necrosis