Outcome Of Papillary Necrosis Causing Acute Renal Failure – A One Year Longitudinal Study In Kles Dr Prabhakar Kore Hospital And Medical Research Centre, Belgaum

Abstract

Background and objectives Renal papillary necrosis is potentially disastrous andmay lead to renal failure. This study was planned to investigate the etiology, clinical spectrum, clinical and short term functional outcome of patients with renal papillary necrosis causing acute renal failure. Methodology This one year longitudinal study was done at the Department of Medicine, Nephrology and Urology, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum. Of the 2000 patients who presenting with acute renal failure from January 2013 to December 2013, 40 patients of acute renal failure due to renal papillary necrosis were studied. Results Of the 40 patients 27 had renal papillary necrosis (RPN) with ARF without CKD and 13 patients had RPN with ARF on CKD. The male to female ratio was1.5:1 and > 70% of the patients were aged > 50 years. Common clinical feature was fever followed by abdominal pain and the commonest co-morbid condition was diabetes mellitus noted in 82.5% of the patients. Diabetes mellitus with pyelonephritis was the commonest etiological factor. On urine microscopy, the presence of WBCs and RBCs was noted in all the patients. Maximum patients with RPN with ARF without CKD had proteinuria 66.67% and E. coli and candida were the common organisms isolated. Imaging showed 87.5% patients with hydronephrosis and hydroureter. The overall functional outcome at 6 months showed that 7.69% were in CKD stage 3, 46.15% in CKD stage 4 and 46.15% were in CKD stage 5. In patients who underwent intervention, renal function improved in 30% patients without change of CKD stage and deteriorated in 70% among the patients having RPN with ARF without CKD. In patients who were managed conservatively, renal function improved in 66.67% patients and deteriorated in 33.33%. Conclusion and interpretation Renal papillary necrosis (RPN) causing acute renal failure (ARF) or acute renal failure on chronic kidney disease (CKD) is more common in males. Most common etiology is Diabetes Mellitus with Pyelonephritis. Diabetics with good glycaemic control also develop RPN with ARF. There is significant increase in e GFR in immediate post treatment period in patients with RPN with ARF without CKD in comparison to ARF with CKD. Outcome of RPN with ARF with or without CKD depends on severity of ARF, etiology, proteinuria and associated sepsis / septicemic shock at presentation. In patients with RPN with ARF with CKD, there is deterioration of renal function in spite of surgical intervention.