Figure 637

Schematic of the progressive stages of the medullary form of renal papillary necrosis and their associated radiologic appearance seen on intravenous pyelography. In partial papillary necrosis the lesion begins as focal necrosis within the substance of the medullary inner stripe. The lesion progresses by coagulative necrosis to form a sinus to the papillary tip, with subsequent extrusion or resorption of the sequestered necrotic tissue. The medullary form of papillary necrosis is commonly encountered in persons with sickle cell hemoglo-binopathy. The incidence of radiographi-cally demonstrative papillary necrosis is as high as 33% to 65% in such persons.

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