Necrosis is the complete destruction of areas of tissue surrounded by healthy parts, resulting in loss of function. In this case, the necrosis refers to the papilla of the kidney; that is, the apex of a malpighian pyramid. The kidneys are a pair of organs situated behind the abdominal organs, which serve to form urine and, indirectly, are regulators of all body fluids.

Papillary necrosis may be caused by urinary tract obstruction such as benign prostatic hyperplasia (BPH); tumors; fibrosis of the urinary collecting system; localized ischemia; urinary tract infections (UTI); and increased pressure within the tubules. In addition, it may be caused by nephrotoxins; urinary calculi; diabetic nephropathy; sickle cell disease; chronic high blood pressure (hypertension); renal failure; glomerular diseases; nephritis within the tubular tissues; congenital anomalies; radiation therapy; surgery; and trauma.

Manifestations of the condition may include fever; weight loss; generalized weakness; changes in urinary flow, frequency, volume or color; kidney pain; kidney enlargement; blood in the urine (hematuria); high blood pressure; and edema.

Diagnostic measures may include: urinalysis and cultures; and blood and chemistry studies. In addition, x-ray; intravenous urography (IVU); pyelography examinations; ultrasonography; magnetic resonance imaging (MRI); computed tomography (CT) scan; and renal biopsy may be indicated.

Treatment may depend on the underlying cause. In addition, it may include: removing any obstruction; medications for infection or pain; surgery; monitoring fluid intake and output and electrolyte balances; hemodialysis; and dietary management. Kidney transplantation may be needed in some cases.

In the event of a kidney transplant, rejection is a lifelong major concern that requires antirejection medications for life. Patients with successful transplants may return to employment. There may be a need for patient education in managing underlying conditions such as diabetes mellitus, sickle cell anemia, and hypertension.

• This disease, (condition), only in its active form , has a 3 year presumptive period and shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied. [38 CFR 3.309 [Disease subject to presumptive service connection], 38 CFR 3.309(a). [chronic disease].

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• The new criteria for the Genitourinary Disease and Conditions body system became effective November 14, 2021.  Review both current and historic criteria prior to any reduction for disabilities established before that date.  38 CFR 3.951(a)

• When evaluating any claim involving loss or loss of use of one or more creative organs, refer to 38 CFR 3.350 of this chapter to determine whether the Veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, there are other conditions in this section which under certain circumstances also establish entitlement to special monthly compensation.

• GFR, estimated GFR (eGFR), and creatinine-based approximations of GFR will be accepted for evaluation purposes when determined to be appropriate and calculated by a medical professional.