ACUTE necrosis of the renal papillae occurs in diabetic patients with acute pyelonephritis and in nondiabetic patients with urinary tract obstruction.1 In a few patients, papillary necrosis has been encountered in the absence of diabetes and urinary tract obstruction.2 However, acute pyelonephritis is a consistent finding.
In four instances, the occurrence of papillary necrosis has been recognized during life by histological examination of tissue passed in the urine.3 Alken,4 in Germany (1938), reported a case of papillary necrosis in a 50-year-old woman with painless hematuria. There was decreased function of the left kidney; Escherichia coli was found in the urine, and pyelography demonstrated a defect in the left upper calyx. Six months later, she returned with renal colic on the left. A portion of tissue was passed in the urine, and the diagnosis was made histologically. Recently, Knutsen and co-workers observed a patient for whom the diagnosis was established by