Renal papillary necrosis (RPN) is the coagulative necrosis of the renal medullary pyramids and papillae brought on by a host of associated conditions and toxins that exhibit synergism towards the development of severe pyelonephritis that is more devastating than usual because of associated disease states particularly diabetes and urinary tract obstructions. Infection is a frequent and important finding in the most of the cases, contributing significantly to the clinical presentation of RPN. We report 4 cases of bilateral renal papillary necrosis detected at autopsy which had associated conditions like diabetes mellitus, sepsis, analgesic abuse and sickle cell anemia respectively.