Renal papillary necrosis is a disorder of the kidneys in which all or part of the renal papillae die. The renal papillae are the areas where the openings of the collecting ducts enter the kidney and where urine flows into the ureters.

Necrosis - renal papillae; Renal medullary necrosis

Renal papillary necrosis often occurs with analgesic nephropathy. This is damage to one or both kidneys caused by overexposure to pain medicines. But, other conditions can also cause renal papillary necrosis, including:

• Diabetic nephropathy
• Kidney infection (pyelonephritis)
• Kidney transplant rejection
• Sickle cell anemia, a common cause of renal papillary necrosis in children
• Urinary tract blockage

Symptoms of renal papillary necrosis may include:

• Back pain or flank pain
• Bloody, cloudy, or dark urine
• Tissue pieces in the urine

Other symptoms that may occur with this disease:

• Fever and chills
• Painful urination
• Needing to urinate more often than usual (frequent urination) or a sudden, strong urge to urinate (urgency)
• Difficulty starting or maintaining a urine stream (urinary hesitancy)
• Urinary incontinence
• Urinating large amounts
• Urinating often at night

There is no specific treatment for renal papillary necrosis. The treatment depends on the cause. For example, if analgesic nephropathy is the cause, your health care provider will recommend that you stop using the medicine that is causing it. This may allow the kidney to heal over time.

How well a person does depends on what is causing the condition. If the cause can be controlled, the condition may go away on its own. Sometimes, people with this condition develop kidney failure and will need dialysis or a kidney transplant.

Health problems that may result from renal papillary necrosis include:

• Kidney infection
• Kidney stones
• Kidney cancer, especially in people who take a lot of pain medicines

Contact your provider for an appointment if:

• You have bloody urine
• You develop other symptoms of renal papillary necrosis, especially after taking over-the-counter pain medicines

Controlling diabetes or sickle cell anemia may reduce your risk. To prevent renal papillary necrosis from analgesic nephropathy, follow your provider's instructions when using medicines, including over-the-counter pain relievers. Do not take more than the recommended dose without asking your provider.

Published Date: September 02, 2025
Published By: Walead Latif, MD, Nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Chen W, Bushinsky DA. Nephrolithiasis and nephrocalcinosis. In: Johnson RJ, Floege J, Tonelli M, eds. Comprehensive Clinical Nephrology. 7th ed. Philadelphia, PA: Elsevier; 2024:chap 60.

Drekonja D, Hooton T. Urinary tract infections in adults. In: Johnson RJ, Floege J, Tonelli M, eds. Comprehensive Clinical Nephrology. 7th ed. Philadelphia, PA: Elsevier; 2024:chap 53.

Gharavi AG, Landry DW. Approach to the patient with renal disease. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 100.