Renal papillary necrosis in children with chronic arthritis
R. C. Allen, R. E. Petty, D. S. Lirenman, P. N. Malleson and R. M. Laxer
Five ambulatory children with various types of chronic arthritis developed
renal papillary necrosis (RPN), as documented by intravenous pyelography.
Each child was being treated with nonsteroidal anti-inflammatory drugs
(NSAIDs) at the time of diagnosis of RPN and had had episodes of gross or
microscopic hematuria for several months prior to diagnosis. In each child
hematuria was associated with more than one NSAID, and three of the five
children also had ingested acetaminophen intermittently. Glomerular
function has remained normal and hypertension has not developed, but
management of these children has necessitated reduction or elimination of
NSAIDs. As evidenced by these five cases, microscopic or gross hematuria in
a child with chronic arthritis treated with anti-inflammatory drugs should
raise the possibility of RPN.
