People in early stages may not have noticeable symptoms. This makes early diagnosis and treatment difficult. But healthcare providers may catch renal papillary necrosis early during evaluation and treatment for the conditions that cause it. As renal papillary necrosis progresses, symptoms may include: Dysuria, painful urination. Fever and chills. Hematuria, blood in your urine visible with the eye or under microscopic examination. Nocturia, frequent urination at night. Pyuria, unusually high amount of white blood cells in urine. Severe flank pain on either side of your back. Urinary tract infections.