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"Diabetes mellitus, obstructive uropathy and urinary infection were considered to be most important in the etiology of renal papillary necrosis in the past literature. However, since 1953, Spuhler and Zollinger reported an association between phenacetin abuse and renal papillary necrosis, the most frequent cause of renal papillary necrosis has been diabetes mellitus, while analgesic abuse (contained phenacetin) has been the second most common factor in recent reports. In the more recent literature, most of the patient have had neither obstructive uropathy nor urinary infection, and it is quite possible that there two condition are of no direct etiological significance. But in this case, we can not suggest definite etiological factor except urinary infection clinically. Only one case is reported showing clinical manifestations laboratory findings, pyelographic findings and pathological changes compare with previous papers."
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