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February 7, 2018

Papillary Necrosis

This kidney biopsy is from an elderly adult patient with acute renal failure and a history of non-steroidal anti-inflammatory medication (NSAID) use. The dominant finding is papillary necrosis, which has two broad etiologies: medullary ischemia and nephrotoxic agents. Medullary ischemia may occur in patients with diabetes, sickle cell anemia, severe arteriolosclerosis, and volume depletion. Nephrotoxic agents associated with papillary necrosis include NSAIDs and phenacetin. It is not possible to know the extent of involvement based solely on core biopsies. The presence of anuria in such a clinical setting would suggest the possibility of diffuse, bilateral disease.