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    flank pain and hematuria

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    A 77-year-old white female who has diabetes mellitus is hospitalized for acute pyelonephritis and improves after 3 days of therapy. On the fourth day, previous symptoms suddenly intensify to produce high fever, colicky flank pain, and grossly bloody urine. Intravenous pyelography demonstrates cavities and sinuses in the region of the papillae.

    What is the most likely diagnosis
    a.acute glomerulonephritis
    b.acute tubular necrosis
    c.renal infarction
    d.renal papillary necrosis

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    d?

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    d.renal papillary necrosis

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    Re: flank pain and hematuria

    Quote Originally Posted by usmlenutz
    A 77-year-old white female who has diabetes mellitus is hospitalized for acute pyelonephritis and improves after 3 days of therapy. On the fourth day, previous symptoms suddenly intensify to produce high fever, colicky flank pain, and grossly bloody urine. Intravenous pyelography demonstrates cavities and sinuses in the region of the papillae.

    What is the most likely diagnosis
    a.acute glomerulonephritis
    b.acute tubular necrosis
    c.renal infarction
    d.renal papillary necrosis
    The correct answer is d. renal papillary necrosis.
    The necrotic tissue may be sloughed off, and it may be present in the urine as tissue, or the tissue may obstruct the renal pelvis or the ureter. Presence of necrotic tissue in the urine increases the risk of urinary tract infections. Necrosis of multiple papillae in the kidney can lead to eventual failure of that kidney.

    Renal papillary necrosis is most commonly associated with analgesic nephropathy, diabetic nephropathy, renal transplant rejection, urinary tract obstruction, kidney infections and sickle cell anemia. Sickle cell anemia is a common cause of renal papillary necrosis in children.

    Intravenous pyelography shows necrosis of the papillae with disruption of the urothelial lining causes tracking of contrast from the fornix parallel to the long axis of the papillae. This can produce the lobster claw sign. Then cavitation of renal papillae occurs, which can be incomplete (medullary) or complete (papillary) and can be either central or eccentric.

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