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Renal Papillary Necrosis and Sickle Cell

Posted Nov 14 2010 3:28am
Written by Sickle Cell Warrior on 14 November 2010

What is Renal Papillary Necrosis?

Renal papillary necrosis is a disorder of the kidneys in which all or part of the renal papillae die.  The renal papillae are ducts that collect urine from the renal lobes and then transfer the urine to the minor calyx (highway of urine in the kidneys). The renal papillae help to concentrate and transfer urine. Due to sickled cells clumping up the tiny venuoles, arterioles and capillaries, oxygen is not delivered to each cell. When there is no oxygen, cells die. When many cells die in one area, eventually the tissue (made up of cells) dies as well.

Who can get RPN?

Many conditions have been associated with triggering RPN, but the underlying thread is that there is an element of ischemia (restriction in blood supply) in all these conditions. If you have 2 or more of these factors, you are at a higher risk for RPN. In addition, if you have sickle cell trait or disease, you might get RPN. With sickle cell, children are more prone to developing RPN. Other associated triggers for RPN are: 

  • Analgesic overuse, especially with NSAIDS like Motrin, Aleve, Ibuprofen
  • Pyelonephritis
  • Obstruction of the urinary tract
  • Tuberculosis
  • Cirrhosis of the liver, chronic alcoholism
  • Renal transplant rejection, radiation
  • Diabetes mellitus
  • Systemic vasculitis

Symptoms of RPN

Since with RPN the kidneys are unable to concentrate urine, there starts to be a backlog of urine and wastes in the system. Many of the symptoms of RPN are related to the kidneys.

  • Back pain or flank pain
  • Bloody urine 
  • Cloudy urine
  • Dark, rust-colored or brown urine 
  • Tissue in the urine
  • Tenderness on the affected kidney

Other symptoms that have been reported include chills, inability to control pee, urinary tract infections, increased urinary frequency or urgency (having to pee RIGHT NOW!), painful urination, large amounts of urine (since there is no concentration), urinary hesitancy (slow to start peeing).

If you are having any of the above symptoms, please mention it to your doctor.

Diagnostics

To diagnose RPN, a urine specimen is collected and analysed for tissue, protein, specific gravity and blood. The doctor may also order an Intravenous Pyelogram (IVP). For this test, a radiographic dye is injected into your bloodstream and the results visualized via Xray. The IVP helps to see the flow of urine in your kidneys, ureters and bladder.

The go-to test is often the CT scan, because this also can check other abdominal structures to make sure all your other organs are intact, and provides better imagery to diagnose RPN and other renal issues with.

Treatment

There is no cure for RPN. Current treatment is to manage the underlying trigger (sickle cell, diabetes etc.) in the hopes that this will resolve the ischemia and hypoxia, and reverse the damage. For sickle cell patients, the treatment of choice is exchange blood transfusions, since this will prevent the cells from ischemia and tissue death and improve oxygen delivery.

Surgical interventions are usually not attempted unless the patient is severely compromised or infected. The surgeon can drain the renal papillae to reduce the pressure, and some might even cut the affected section out of the kidney. Another technique is to place a filter in the kidney that strains the dead slough tissue from the renal papillae.

Alternative Management

  • Water is the first step in home management. Since the urine is not concentrated, patietns with RPN are often dehydrated. In sickle cell, being dehydrated could lead to a crises, so preventing this is key.
  • Having a diet rich in anti-oxidants can help prevent and reduce the inflammation and tissue damage associated with RPN.
  • Ginger helps to cleanse the kidneys of the dead tissue. 
  • Uva Ursi is an excellent all natural herb which stimulates the functionality of the kidneys while also strengthening and toning the urinary tract passageways.
  • Protect from infection

Although RPN is uncurable, caution must be taken to prevent this complication from getting worse, and growing into full blown kidney disease. Learn the symptoms, talk to your doctor and be well. Knowledge is power.

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