questions 2

Renal Papillary Necrosis

Topic updated on 06/14/15 12:48pm

  • ring signNecrosis of the renal papillae with resultant sloughing into the urinary space
  • Caused by
    • a recent infection
    • immunological reaction
    • often a complication of tubulointerstitial nephritis (TIN) 
  • Associated conditions
    • diabetes mellitus
    • chronic NSAID use 
      • MCC is acetominophen + aspirin
    • sickle cell anemia
    • acute pyelonephritis
  • Symptoms
    • gross hematuria
    • proteinuria
    • acute, colicky flank pain
  • IVP
    • shows "ring defect" where necrosed papilla used to reside


Qbank (2 Questions)

(M2.RL.32) A 78-year-old male with a history of herpes zoster and debilitating osteoarthritis presents to general medical clinic with painless hematuria. He has significant deformity in multiple joints. He reports that his ankles are giving him the most trouble, and he is scheduled for ankle replacement in the coming months. However, he is quite concerned that his recent urinary symptoms may prevent him from going to surgery. Vital signs are stable. Physical is within normal limits. He has no groin pain, flank pain, or costovertebral angle tenderness. There is no blood at the urethral meatus. Urinary analysis reveals 2+ heme. Routine labs are drawn, and serum creatinine is 3.5. Which drug is most likely to result in these symptoms, and if a renal biopsy is taken, what would one expect to find? Topic Review Topic

1. Drug: naproxen; Biopsy: papillary necrosis and chronic tubulointerstitial nephritis
2. Drug: naproxen; Biopsy: segmental sclerosis and hyalinosis
3. Drug: naproxen; Biopsy: wire looping of capilaries
4. Drug: acyclovir; Biopsy: antibodies to the glomerular basement membrane
5. Drug: acyclovir; Biopsy: split basement membrane

(M2.RL.40) A 43-year-old Caucasian female with a long history of uncontrolled migraines presents to general medical clinic with painless hematuria. She is quite concerned because she has never had symptoms like this before. Vital signs are stable, and her physical examination is benign. She denies any groin pain, flank pain, or costovertebral angle tenderness. She denies any recent urinary tract infections or dysuria. Urinary analysis confirms hematuria and a serum creatinine returns at 3.0. A renal biopsy reveals papillary necrosis and a tubulointerstitial infiltrate. What is the most likely diagnosis? Topic Review Topic

1. Analgesic nephropathy
2. Kidney stone
3. Bladder cancer
4. Kidney cancer
5. Sickle cell disease


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