Renal imaging: papillary necrosis: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Renal imaging: papillary necrosis

Sample item

A diabetic patient with chronic analgesic use and loin pain passes tissue fragments in urine. An IVU shows several calyces with ring-shaped contrast collections at the papillary tips and a clubbed appearance. What is the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Renal papillary necrosis

Ischaemic necrosis of the papillae makes them slough, leaving contrast-filled clefts and ring shadows when a sloughed papilla is outlined. Diabetes, analgesic nephropathy, sickle cell disease and obstruction with infection are the classic causes.

Option by option

  • A. Renal tuberculosis only

    Renal tuberculosis can mimic this, but the clinical setting here best fits papillary necrosis.

  • B. Polycystic kidney disease

    Polycystic kidneys show spider-leg calyces.

  • C. Medullary sponge kidney

    Medullary sponge kidney shows a brush-like contrast blush in the pyramids with stones.

  • D. Renal papillary necrosis (correct)

    Correct. Ring shadows and clubbed calyces after papillary slough are characteristic.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is D, Renal papillary necrosis. Ischaemic necrosis of the papillae makes them slough, leaving contrast-filled clefts and ring shadows when a sloughed papilla is outlined.

Why is "Renal tuberculosis only" not the answer?

Renal tuberculosis can mimic this, but the clinical setting here best fits papillary necrosis.

Why is "Polycystic kidney disease" not the answer?

Polycystic kidneys show spider-leg calyces.

Why is "Medullary sponge kidney" not the answer?

Medullary sponge kidney shows a brush-like contrast blush in the pyramids with stones.

What concept does this question test?

It tests Renal imaging: papillary necrosis in Radiology. Diabetes, analgesic nephropathy, sickle cell disease and obstruction with infection are the classic causes.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Renal imaging: papillary necrosis?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.