Renal failure Quiz: Ace Your Exams

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A 50-year-old woman comes to the emergency department for evaluation of right-sided flank pain and dark urine for the past few hours. The patient states, “I thought my back was acting up again so I took two extra naproxen today. I decided to come get checked out once my urine appeared dark.” The patient denies dysuria, urinary frequency, urgency, fever or chills. Past medical history includes type 2 diabetes mellitus, chronic lumbosacral back pain and migraine headaches. Current medications include phenacetin, acetaminophen, ibuprofen, naproxen and insulin. Temperature is 37.1°C (98.8° F), pulse is 85/min, respirations are 21/min, and blood pressure is 130/70 mm Hg. Serum creatinine is 1.9 mg/dL. Urinalysis is shown.  

 Laboratory value  Result 
 Urinalysis 
 Color  Clear 
 Specific gravity  1.013 
 Protein  1.0 g/day 
 Blood  Positive 
 Leukocyte esterase  Negative 
 Leukocytes  1-2/hpf 
 Erythrocytes  40-42/hpf 
 Dysmorphic RBCs  Absent 
 Casts  None 
   
Which of the following is the most likely etiology of this patient’s hematuria? 

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