Abstract:
Renal papillary necrosis (RPN) is characterized by coagulative necrosis of the renal
medullary pyramids and papillae. Multiple conditions and toxins are associated with RPN. Several
RPN risk factors, or POSTCARDS, have been identified, with most patients presenting with RPN
having at least two contributing risk factors. Currently, there is no specific test to diagnose and
confirm RPN; however, several imaging tools can be used to diagnose the condition. RPN is currently
underdiagnosed in African populations, often with fatal outcomes. In African clinical settings, there
is a lack of consensus on how to define and describe RPN in terms of kidney anatomy, pathology,
endourology, epidemiology, the identification of African-specific risk factors, the contribution of
oxidative stress, and lastly an algorithm for managing the condition. Several risk factors are unique to
African populations including population-specific genetic factors, iatrogenic factors, viral infections,
antimicrobial therapy, schistosomiasis, substance abuse, and hypertension (GIVASSH). Oxidative
stress is central to both GIVASSH and POSTCARDS-associated risk factors. In this review, we present
information specific to African populations that can be used to establish an updated consensual
definition and practical grading system for radiologists, urologists, nephrologists, nuclear physicians,
and pathologists in African clinical settings.
