ALTHOUGH the pathological entity of renal papillary necrosis was recognized as early as 1877 by Von Friedreich, it is remarkable that prior to 1954 only 6 cases had been reported in which this diagnosis was correctly made ante mortem (Hultengren, 1958). During the last five years, awareness of this condition and improvements in radiological technique have been responsible for an ever-increasing number of case reports. Several excellent and full reviews are now available (Lindvall, 1960; Hultengren, 1961 ; Lauler, Schreiner, and David 1960).
Papillary necrosis remains a vague entity to many, and concepts of its aetiology, course, and management are tentative. Of particular importance is whether the pathological lesion of papillary necrosis is part of a single disease entity, or is the result of many different processes, perhaps having a final common anatomical and pathological abnormality as their end-result.
Our recent experience with this disease is reviewed both to emphasize the clinical presentation and radiological features of the disease as it is seen here, and to make suggestions, derived from our observations, regarding management.
Ten cases are summarized in Tables Z, ZZ. Two broad groups of patients emerged. Cases 1-8 presented as cases of severe loin pain or ureteric colic with pyuria, and this was almost certainly due to the passage or impaction of necrotic papillary fragments. All these patients were women, 6 of them in the third or early fourth decade. They have been labelled Group I.
In Cases 9 and 10 the papillary necrosis was discovered incidentally at autopsy, both patients having severe pyelonephritis. These have been labelled Group 2. Case 9 presented as renal failure, without previous history of any urinary disturbance and in Case 10 papillary necrosis was found incidentally at autopsy in a patient who died following a head injury.