Renal medullary necrosis

Hematuria in a 42-Year-Old Woman

“…Obstructive uropathy has been reported as the cause of RPN in 15-39% of the major series of papillary necrosis [5,23,26]. The highest incidence of obstruction reported has been 84% in a series of 42 cases of RPN [39], This series is exceptional not only in this regard but also in the fact that diabetes mellitus accounted for only 17% of the cases.…”

“…All of these urinary abnormalities were present in this patient. The disease is basically one of the older age group occurring in patients over 60 years of age and less fre quently in the age group of 40-60 [5,23,26]. It is uncom mon in individuals below 40 years of age, except for those with sickle cell hemoglobinopathy in whom the disease occurs in the younger age group and obviously shows the unexpected racial predominance affecting primarily the black population.…”

“…i.e. diabetes mellitus, urinary tract obstruction and urinary tract infection, identified by the turn of the century, remained as the only causes of RPN considered over the next 50 years; with most authors considering RPN as a form of acute or chronic pyelonephritis that develops in patients with diabetes mellitus or urinary tract obstruction [26,31],…”

“…The first comprehensive review to focus attention on RPN was that of Mandell [26] in 1952. In this collected series of 160 cases of RPN from the world's literature, 96 patients or 60% of the cases had diabetes mellitus, 48 patients or 30% of the cases had urinary tract obstruc tion, and 15 patients or 9.4% of the cases had urinary obstruction and diabetes.…”

“…reflecting the frequency of urinary tract obstruction in elderly men. Subsequent reports emphasized the role of infection and pyelonephritis which came to be considered by several authors as probably the most common factors predisposing to renal papillary necrosis [5,8,26].…”