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