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Renal Papillary Necrosis

Medically Reviewed.Last updated on 07/15/2026.

Renal papillary necrosis is a condition that damages parts of your kidney. It can block parts of your urinary tract and lead to infections or chronic kidney disease. Some symptoms include pain when you pee, side or back pain, and pus, blood or tissue in your pee. Common causes include diabetes, sickle cell disease and overuse of pain relievers.

What Is Renal Papillary Necrosis?

Renal papillary necrosis is a condition where parts of your kidney (renal papillae) aren’t getting enough blood flow. This causes tissue in your kidney to die. The tissue can break off and move into your urinary tract.

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Papillary necrosis can affect one or both kidneys.

Symptoms and Causes

Symptoms of renal papillary necrosis

In the early stages, you might not have noticeable symptoms. As renal papillary necrosis progresses, symptoms could include:

  • Pain when you pee
  • Fever
  • Frequent urination at night
  • Pus, blood or pieces of tissue in your pee
  • Severe pain on either side of your back
  • Frequent urinary tract infections (UTI)

Renal papillary necrosis causes

The most common causes of renal papillary necrosis include:

Other conditions that can lead to renal papillary necrosis include:

  • Chronic liver disease
  • Kidney infection
  • Tuberculosis in your kidneys or urinary tract
  • Blood clots in the blood vessels of your kidneys
  • Blockage in your urinary tract
  • Blood vessel inflammation

Complications

If not treated, renal papillary necrosis can lead to:

Diagnosis and Tests

How doctors diagnose renal papillary necrosis

Healthcare providers diagnose renal papillary necrosis using:

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Papillary necrosis can be hard to diagnose early. Symptoms don’t always show up until there’s a lot of damage. Your provider may do tests like routine bloodwork and urinalysis to catch any issues early.

Management and Treatment

How is renal papillary necrosis treated?

There isn’t one specific treatment for renal papillary necrosis. You might need:

  • Fluids to keep you properly hydrated
  • Antibiotics to treat infections
  • Surgery to treat blockages

In severe cases, you may need dialysis or a kidney transplant. Your provider will also help you manage any health conditions that can cause papillary necrosis.

When should I see my healthcare provider?

Talk to your provider if you experience:

  • Blood in your pee
  • Pain when you pee
  • Severe pain on either side of your back between your hip bones and ribs

If you have a condition that puts you at risk for renal papillary necrosis, talk to your provider about ways to reduce your risk and how to recognize early symptoms.

Outlook / Prognosis

What can I expect if I have renal papillary necrosis?

Your experience with renal papillary necrosis depends on how much damage there is and the cause. In some cases, kidney function improves with treatment. In others, the damage may continue to get worse. In severe cases, it can cause life-threatening complications.

Your provider will likely recommend that you stay hydrated and not use certain medications, like NSAIDs (aspirin, ibuprofen, naproxen). Ask your provider what to expect.

Prevention

Can this be prevented?

Managing ongoing health conditions, like diabetes and sickle cell disease, and staying hydrated are the best ways to reduce your risk of renal papillary necrosis. Your provider may check your kidney function periodically to catch any issues early.

Be careful not to go over the recommended dosage of pain medications. If you find yourself taking them regularly, talk to your healthcare provider.

A note from Cleveland Clinic

We don’t think about our kidneys a lot. But they play a critical role in keeping us healthy. If you have a health condition or take medications that put you at higher risk for renal papillary necrosis, there are steps you can take to catch any issues early. Talk to your provider about how to protect your health.

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Medically Reviewed.Last updated on 07/15/2026.

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References

Cleveland Clinic’s health articles are based on evidence-backed information and review by medical professionals to ensure accuracy, reliability and up-to-date clinical standards.

Care at Cleveland Clinic

If you have a condition that’s affecting your kidneys, you want experts by your side. At Cleveland Clinic, we’ll work with you to craft a personalized treatment plan.

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