A 58-year-old man with poorly controlled diabetes mellitus (HbA1c 9.2%) and chronic NSAIDs use presents with gross hematuria and colicky left flank pain. Vital signs: BP 156/92, HR 98, RR 16, Temp 37.2°C, SpO2 98%. Serum creatinine is 2.1 mg/dL. CT imaging reveals sloughed necrotic material within the renal collecting system. Urinalysis shows no proteinuria. Which of the following is the most likely diagnosis?

  1. A)Acute cystitis
  2. B)Renal papillary necrosisGABARITO
  3. C)Membranous nephropathy
  4. D)Autosomal recessive polycystic kidney disease
  5. E)Minimal change disease

Explicação

Renal papillary necrosis is associated with the mnemonic SAAD papa: sickle cell disease, acute pyelonephritis, analgesic nephropathy, diabetes mellitus, and severe obstruction. Sloughing of necrotic papillae can cause hematuria and obstruction like symptoms. Ver explicação completa e trilha adaptativa →

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