What is papillary necrosis significance and presentation?

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Papillary necrosis is the death of renal papillae caused by ischemia or toxin exposure, which can lead to sloughing of tissue into the collecting system and sometimes obstruction or bleeding. The classic associations are analgesic nephropathy from long-term analgesic use, diabetes mellitus, and sickle cell disease or trait. Clinically, patients typically have flank pain and hematuria, and in some cases you can actually pass a piece of papillary tissue in the urine. This combination of risk factors with the characteristic presentation distinguishes this condition from other urinary problems. It’s not driven by trauma alone, not limited to children, and it’s not a mild reversible condition, since it represents tissue necrosis that can lead to obstruction or infection.