Clinical Image

Renal Papillary Necrosis in a Patient with Haemophilia

Lara-Anne Delicata* and Rachel Hung
Department of Renal Medicine and Transplantation Royal Free London NHS Foundation Trust, London, UK


*Corresponding author: Lara-Anne Delicata, The Vischio, Eugene Borg Street, Haz Zebbug, ZBG2392, Malta


Published: 21 Mar, 2018
Cite this article as: Delicata L-A, Hung R. Renal Papillary Necrosis in a Patient with Haemophilia. Clin Case Rep Int. 2018; 2: 1044.

Clinical Image

A 49-year-old Caucasian male was referred to the nephrology clinic in view of a rise in serum creatinine from baseline of 80 mmol/L to 125 mmol/L and intermittent macroscopic haematuria. He is human immunodeficiency virus positive, has severe haemophilia A and hepatitis C with related liver cirrhosis. He currently takes atazanavir, raltegravir and ritonavir and uses non-steroidal anti-inflammatory drugs (NSAIDS). He has a urine protein creatinine ratio of 96 mg/mmol. A CT urogram demonstrated extensive bilateral papillary necrosis (RPN). Computed tomography urogram demonstrating extensive bilateral papillary necrosis (Figure 1). RPN occurs when the renal medullary pyramids and papillae undergo necrosis due to ischemic conditions. Ischemia occurs due to collective insults from different risk factors; in this case the use of NSAIDS compounded with bleeding from haemophilia. A month later, his renal function recovered back to baseline. RPN is diagnosed via imaging studies and has a good prognosis. Bilateral Renal papillary necrosis with irregular collections of contrast arising from the calyces and distortion of the medullary-calyceal anatomy (Figure 2).


Figure 1

Another alt text

Figure 1
Computed tomography urogram demonstrating extensive bilateral papillary necrosis.

Figure 2

Another alt text

Figure 2
Bilateral Renal papillary necrosis with irregular collections of contrast arising from the calyces and distortion of the medullary-calyceal anatomy.