Renal Papillary Necrosis in Diabetic Patients

Abstract

A retrospective interpretation of the medical literature reveals the description of several cases of probable renal papillary necrosis (RPN), dating back to the ninth century [1]. However, it was in 1877 that RPN was actually identified as a distinct clinicopathologic entity in a man who had prostatic hypertrophy, hydronephrosis, and bilateral papillary necrosis [2]. Shortly thereafter, the first case of RPN in a diabetic was reported in a 60-year-old diabetic woman who presented with gangrene of the left foot and at postmortem examination had RPN [3]. The propensity of diabetic patients to papillary necrosis was first emphasized in 1937 by Froboese [4] and by Günther [5]. Seven of the cases of RPN described by Günther were from a series of 58 autopsies in which suppurative pyelonephritis had been noted [6]. Five of these seven were diabetics. Thus, from the outset a strong association was made between coexistent urinary tract infection in diabetics with RPN. It is not unexpected, then, that most of the initial reports that followed considered RPN as a fulminant terminal complication of severe acute pyelonephritis in diabetic patients [6–9]. Subsequent reports described a more indolent chronic form of RPN in diabetics with urinary tract infection and recurrent episodes of pyelonephritis [10, 11]. The general consensus that emerged ultimately was that RPN is a form of renal parenchymatous destruction that develops in the course of either acute or chronic pyelonephritis that occurs in patients with diabetes mellitus [12–14].