ACUTE necrosis of the renal papillae is one of the most conspicuous L changes that may be seen in the kidneys of diabetic patients. It is a part of acute pyelonephritis, which may be fulminating in type. Papillary necrosis occurs also in nondiabetic persons with chronic urinary obstruction. Recovery is only occasionally seen. Although it is an important complication of diabetes, it has received little attention in the medical literature or textbooks, especially in America. As the condition has been only partially reviewed in the past, a more complete résumé seems pertinent.
The association of necrosis of the papillae and diabetes mellitus was first emphasized by Günther,1 in 1937. However, as he mentioned, reports of the anatomic lesion as seen both in diabetic and in nondiabetic patients go back much further. Friedreich's2 report in 1877 was apparently the first. His patient was a man of 70 years who