Renal papillary necrosis

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Renal papillary necrosis

Pathology

Flashcards

Renal papillary necrosis

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Questions

USMLE® Step 1 style questions USMLE

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A 50-year-old man comes to his primary care PA’s office for routine follow-up. He was recently diagnosed with osteoarthritis of the knees four weeks ago and was initiated on analgesic medications. Past medical history is significant for diabetes mellitus. Current medications include metformin, naproxen and acetaminophen. His vitals and physical exam are within normal limits. Laboratory results are as follows.

 Laboratory value  Results  Reference range 
  4 weeks ago  Today  
 Serum chemistry  
 Sodium  138 mEq/L  137 mEq/L  136-146 mEq/L 
 Potassium  4 mEq/L  4.1 mEq/L  3.5-5 mEq/L 
 Bicarbonate  24 mEq/L  25 mEq/L  22-28 mEq/L 
 Chloride  96 mEq/L  94 mEq/L  95-105 mEq/L 
 Creatinine  1.1 mg/dL  1.6 mg/dL  0.6-1.2 mg/dL 
 Urinalysis  
 Protein  100 mg/day  102 mg/day  <150 mg/day 
 Cast  None  None  None 
 Blood  None  None  None 


Changes to which of the following anatomic regions is most likely accountable for this patient’s rise in creatinine? 

Key Takeaways

Renal papillary necrosis is a condition in which impaired blood supply to the kidneys leads to diffuse ischemia and subsequent necrosis of the renal papilla. Risk factors for renal papillary necrosis include diabetes, sickle cell anemia, and certain medications such as non-steroidal anti-inflammatory drugs (NSAIDs). Symptoms may include fever, flank pain, and blood in the urine. Treatment may include antibiotics, pain management, and in severe cases, surgery.