Papillary necrosis

- chronic consumption of large amounts of analgesics (NSAIDs) leads to chronic tubulointerstitial nephritis and papillary necrosis

- diuretics may exacerbate any renal hypotension

- can cause pain and sterile pyuria

- urinary tract obstruction may occur owing to sloughing of renal papilla

- radiographic findings in papillary necrosis (always bilateral)

- IVU : clubbed calyces, ring sign (arrow) due to sloughed papilla

- causes of renal papillary necrosis may be recalled as 'POSTCARDS'

• pyelonephritis
• obstruction of renal tract
• shock
• TB
• cirrhosis of liver
• analgesic nephropathy
• renal transplant rejection
• diabetes
• sickle cell