A 58 year old woman with long standing diabetes mellitus and chronic back pain presents with gross hematuria. She reports daily use of multiple over the counter pain medications for many years. Urinalysis shows microscopic hematuria and mild proteinuria. CT imaging suggests sloughed papillae. Which of the following is the most likely diagnosis?
- A)Renal artery stenosis
- B)Minimal change disease
- C)Papillary necrosisGABARITO
- D)Autosomal dominant polycystic kidney disease
- E)Membranous nephropathy
Explicação
Papillary necrosis is correct. Chronic analgesic use and diabetes are classic risk factors for ischemic necrosis of the renal papillae. The mnemonic NSAID, sickle cell disease, acute pyelonephritis, diabetes mellitus captures common associations. Ver explicação completa e trilha adaptativa →