Renal Papillary Necrosis in Diabetic Patients
Cases of probable renal papillary necrosis (RPN) may have been described for centuries, but it was not until 1877 that RPN was actually identified as a distinct clinicopathological entity in a man who had prostatic hypertrophy, hydronephrosis and bilateral papillary necrosis [1,2]. Shortly thereafter, the first case of RPN in a diabetic was reported in a 60-year old diabetic woman who presented with gangrene of the left foot and at post-mortem had RPN . The propensity of diabetic patients to papillary necrosis was first emphasized in 1937 [4,5]. From the outset a strong association was made between coexistent urinary tract infection in diabetics with RPN, and most of the initial reports considered RPN as a fulminant terminal complication of severe acute pyelonephritis in diabetic patients [6–9]. Subsequent reports described a more indolent chronic form of RPN in diabetics, generally in those with recurrent episodes of urinary tract infection, but not necessarily with coexistent pyelonephritis [10–12]. Since the advent of antibiotics and improved management of urinary tract infection, the principal role once attributed to infection in the development of RPN in diabetics has been further eroded while that of diabetic vasculopathy has come to be recognized as the major cause.
KeywordsDiabetic Patient Urinary Tract Infection Acute Pyelonephritis Prostatic Hypertrophy Urinary Tract Obstruction
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