Renal papillary necrosis is a type of damage that occurs in your kidneys. It decreases kidney function and can lead to kidney failure. You can prevent renal papillary necrosis by managing the conditions that cause it, such as diabetes. Also be careful when taking NSAID pain relievers, which can cause renal papillary necrosis if overused.
Kidneys filter waste out of your blood and help maintain fluid levels in your body. Most people are born with two kidneys.
Blood enters your kidneys through your renal arteries, which split into smaller and smaller blood vessels. In the outer part of your kidney, special cells sit next to the tiny blood vessels and pull waste products and water out of your blood.
The watery waste, or urine, travels through tiny tubes toward the center of your kidney. This middle region of your kidney is the medulla. It contains funnel-shaped sections of tissue. Within each funnel, the tiny tubes empty into larger collecting ducts. The area at the tip of the funnel where the collecting ducts meet is your renal papilla.
From the renal papillae, urine empties into the center area of your kidney. It then travels through your ureter to your bladder and out of your body through your urethra.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
It occurs most often in people over 60 and is more common in women and people assigned female at birth.
Many conditions and factors can cause renal papillary necrosis. The most common are:
Other conditions and diseases that can lead to renal papillary necrosis include:
In about 7 out of 10 cases, the condition affects both kidneys.
People in early stages may not have noticeable symptoms. This makes early diagnosis and treatment difficult. But healthcare providers may catch renal papillary necrosis early during evaluation and treatment for the conditions that cause it.
As renal papillary necrosis progresses, symptoms may include:
Healthcare providers diagnose renal papillary necrosis using:
Kidney function tests can also help your provider diagnose this condition. These include:
If not treated, renal papillary necrosis can lead to chronic kidney disease (CKD), kidney failure, dialysis and kidney transplant. Renal papillary necrosis is also associated with transitional cell cancer of the kidney or ureter.
There isn’t a specific treatment for renal papillary necrosis. Treatment involves managing the underlying cause to limit further damage to your kidneys.
The effectiveness of treatment will depend on the extent of the damage. In severe cases, renal papillary necrosis may continue to progress after treatment. In less severe cases, kidney function may stabilize or even improve.
You can prevent this condition by maintaining good overall health. Use NSAIDs (or other over-the-counter medications) according to the manufacturer’s or provider’s instructions.
If you have diabetes, sickle cell disease or another condition that causes renal papillary necrosis, follow your healthcare provider’s care instructions and attend regular appointments. You’ll need routine lab tests to assess your kidney function and detect any changes early.
Your prognosis depends on the cause and extent of the damage. People with diabetes have poorer outcomes because it’s a long-term disease and not always well-controlled. If you have diabetes, managing it the best you can will help you prevent damage to your kidneys.
Severe renal papillary necrosis can be severe and lead to dialysis and kidney transplantation. It can be fatal if infections develop. Death can also occur due to kidney failure.
In sickle cell disease, renal papillary necrosis is one of several complications that can develop in your kidneys. Together, these complications greatly reduce a person’s life expectancy.
Talk to your provider if you experience:
A note from Cleveland Clinic
Your kidneys play an essential role in your body, filtering out waste and maintaining water balance. Uncontrolled diabetes, overuse of NSAID pain relievers and other conditions can damage your kidneys and cause renal papillary necrosis. In the early stages of renal papillary necrosis, you may not even know you have a problem. If you have diabetes or frequently take NSAIDs, talk to your provider about steps you can take to protect your kidneys.
Last reviewed by a Cleveland Clinic medical professional on 07/08/2022.
Learn more about our editorial process.