Genitourinary Radiology > Collecting System > Calyces & Pelvis > Papillary Necrosis

Papillary Necrosis


Ischemic necrosis of the renal papilla occurs most commonly in middle-aged men and women, and elderly women. Etiologies are covered by the mnemonic POSTCARD: pyelonephritis, obstruction, sickle cell anemia, tuberculosis, cirrhosis, analgesics, renal vein thrombosis, and diabetes mellitus.

Plain radiographs show calcification in sloughed, usually ring-shaped, papilla (though this is not a feature of hemoglobinopathy-related papillary necrosis). Bilaterally small, irregularly scarred kidneys with medullary nephrocalcinosis strongly suggests analgesic nephropathy.

CT IVP in patient with hematuria. Enhanced images show contrast filling a defect in this left calyx from where the papilla has sloughed (yellow arrow). On a different slice, we actually see the sloughed papilla in the contrast (red arrow). Notice that this piece of soft tissue is surrounded by contrast and that it is NOT connected to the rest of the papilla because it has sloughed into the collecting system. This may serve as a nidus for calcification or may obstruct the collecting system.

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