Renal Papillary Necrosis: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 2, 2026.
What kind of doctor treats Renal Papillary Necrosis?
A nephrologist, a doctor who specializes in kidney diseases, usually manages renal papillary necrosis. Urologists may also be involved if blockages are present. The exact team depends on the cause and severity. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What it is
Renal papillary necrosis is a condition in which small areas of kidney tissue die. Each kidney has tiny pointed sections called papillae, which send urine into the tubes that carry it to the bladder. In renal papillary necrosis, one or more of these papillae lose their blood supply and break down, and the damaged tissue can pass into the urine.
Symptoms
Some people have no symptoms at all. When symptoms do appear, they can include blood in the urine, pain in the side or back, fever, or passing small pieces of tissue. If dead tissue blocks the urinary tract, it can cause severe pain or trouble passing urine, which needs prompt medical care.
Causes and who gets it
Renal papillary necrosis happens when the papillae do not get enough blood. Long-term diabetes is one of the most common causes, and frequent or long-term use of NSAIDs (nonsteroidal anti-inflammatory drugs) can also raise the risk. Other causes include repeated kidney infections, urinary tract blockages, sickle cell disease, and severe dehydration; adults with diabetes or kidney disease are the most likely to develop it.
How doctors diagnose it
Doctors start with a medical history, a physical exam, and questions about medicines. Urine tests can show blood, infection, or tissue pieces, while imaging such as a CT scan can show changes in the kidney. Blood tests help show how well the kidneys are working.
Treatment
Treatment depends on the cause. Doctors may control diabetes, treat infections with antibiotics, remove blockages, or ask patients to stop using NSAIDs. Drinking enough fluids matters, especially for people with sickle cell disease, and regular follow-up care helps doctors watch kidney health over time.
When to see a doctor
Anyone who notices blood in the urine, pain in the side or back, fever, or trouble passing urine should contact a doctor. Sudden severe pain, high fever, or an inability to pass urine needs urgent care. People with diabetes or kidney disease should mention their medical history during any visit about urinary symptoms.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Either can order urine tests, blood tests, and imaging, and manage related problems such as diabetes or high blood pressure. If tests point to renal papillary necrosis, they will refer the patient to a nephrologist. These practices often offer longer visits and easier scheduling.
Common questions
Is renal papillary necrosis the same as kidney failure?
No. It means small areas of kidney tissue have died, and many people keep most of their kidney function. In some cases, though, long-term damage can lead to chronic kidney disease.
Can it go away on its own?
The dead tissue does not grow back. Treating the cause can help protect the rest of the kidney.
Do pain relievers like ibuprofen cause it?
Heavy or long-term use of NSAIDs, the class of pain relievers that includes ibuprofen, is a known risk factor. Occasional use as directed is different from chronic heavy use. Anyone worried about their pain medicine should talk to a doctor.
Sources
- MedlinePlus - Kidney Diseases
- National Institute of Diabetes and Digestive and Kidney Diseases - Kidney Disease - NIDDK
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
