Renal papillary necrosis

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Renal papillary necrosis

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A 50-year-old man comes to his primary care physician’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 
  4 weeks ago  Today 
 Serum chemistry 
 Sodium  138 mEq/L  137 mEq/L 
 Potassium  4 mEq/L  4.1 mEq/L 
 Bicarbonate  24 mEq/L  25 mEq/L 
 Chloride  96 mEq/L  94 mEq/L 
 Creatinine  1.1 mg/dL  1.6 mg/dL 
 Urinalysis 
 Protein  100 mg/day  102 mg/day 
 Cast  None  None 
 Blood  negative  negative 
   
Changes to which of the following anatomic regions is most likely accountable for this patient’s rise in creatinine?  

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Acute pyelonephritis p. 619

renal papillary necrosis and p. 619

Diabetes mellitus p. 350-358

renal papillary necrosis and p. 619

Hematuria p. 614

renal papillary necrosis p. 621-NaN

Nonsteroidal anti-inflammatory drugs (NSAIDs) p. 495

renal papillary necrosis p. 620

Proteinuria p. 613

renal papillary necrosis and p. 620

Renal papillary necrosis p. 619

pyelonephritis and p. 619

sickle cell anemia p. 415

Sickle cell disease

renal papillary necrosis p. 621

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Summary

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.

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