Activated macrophages produce and secrete tumor necrosis factor. Cell adhesion molecules are degraded by syncytiotrophoblast secretion of Tumor necrosis factor-alpha. Analgesic nephropathy is a common cause of renal papillary necrosis. Toxicity may also include hypotension, blindness and hepatic necrosis. This leads to an ischemic cascade of intracellular changes, necrosis and apoptosis of affected cells. Certolizumab pegol is a monoclonal antibody directed against tumor necrosis factor alpha. Complications may include nonunion of the fracture, avascular necrosis, and arthritis. This causes ischemia and often leads to ischemic necrosis of tissue. CD27 is a member of the tumor necrosis factor receptor superfamily. Promoting the inflammation, IL-17 acts in concert with tumor necrosis factor and interleukin-1. Causes include kidney failure, glomerulonephritis, acute tubular necrosis, or other kidney disease. Pathogenesis involves widespread tissue necrosis and disintegration. Potassium deficiency may cause necrosis or interveinal chlorosis. Angiosarcomas show signs of hemorrhage and necrosis. This is followed by considerable swelling, blistering, necrosis, and ulceration.