Renal Papillary Necrosis in Acute Pyelonephritis: Pathogenesis, Diagnosis, and the Role of Relook Flexible Ureterorenoscopy
Suryaram Aravind
Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.
Punith Jain
Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.
Hariharasudhan Sekar
Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.
Velmurugan Palaniyandi
Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.
Vivek Meyyappan
Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.
Sriram Krishnamoorthy *
Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.
*Author to whom correspondence should be addressed.
Abstract
Renal papillary necrosis (RPN) is an under-recognised complication of acute pyelonephritis (APN), especially in high-risk populations like diabetics. This chapter explores the vascular and infectious pathophysiology underlying RPN, describes its classic and atypical presentations, and highlights the emerging role of relook flexible ureterorenoscopy (F-RURS) in identifying and removing necrosed papillae. Recent case reports and small series suggest that timely endoscopic removal of necrotic debris reduces recurrence and improves renal outcomes. This chapter aims to equip clinicians with a structured approach to suspect, investigate, and intervene upon RPN in the APN setting.
Keywords: Renal papillary necrosis, acute pyelonephritis, flexible ureterorenoscopy, diabetes, Sloughed papilla, hydronephrosis, obstructive uropathy