Renal papillary necrosis



Renal papillary necrosis

Renal system


Renal papillary necrosis


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USMLE® Step 1 questions

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Renal papillary necrosis

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USMLE® Step 1 style questions USMLE

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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 
 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. 625

renal papillary necrosis and p. 625

Diabetes mellitus p. 352-360

renal papillary necrosis and p. 625

Hematuria p. 620

renal papillary necrosis p. 627-NaN

Nonsteroidal anti-inflammatory drugs (NSAIDs) p. 499

renal papillary necrosis p. 626

Proteinuria p. 619

renal papillary necrosis and p. 626

Renal papillary necrosis p. 625

pyelonephritis and p. 625

sickle cell anemia p. 417

Sickle cell disease

renal papillary necrosis p. 627

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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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