NECROTIZING RENAL PAPILLITIS

Abstract

This paper includes a review of the literature regarding necrotizing renal papillitis and a report of 3 interesting cases. This is a severe type of suppurative renal infection most commonly seen in diabetics or in association with obstruction of the urinary tract. The etiology is uncertain and the authors question the previously proposed acute pyelonephritis as a causitive factor in this disease. The organisms commonly involved are Staphylococcus aureus and the colon bacillus. The pathological picture is that of necrosis of the renal papillae and pyramids. The vascular structure of the kidney is not involved in this process. A correct clinical diagnosis is possible if one is aware of the disease and familiar with its associated symptomatology. It behooves one to suspect this disease when dealing with nondiabetic as well as diabetic patients who develop acute renal insufficiency. The therapeutic approach to this problem concerns itself with prophylaxis as well as treatment of the active infection. Although the mortality rate has approximated 100% in the past, it is quite possible that in the future many of the newer antibiotic agents will be capable of controlling renal infection and preventing terminal necrotizing renal papillitis.