Renal

Question 1

renal papillary necrosis (RPN)

Answer 1

• Abrupt-onset gross hematuria in an otherwise healthy patient with a family history of sickle cell disease - - -

Conditions associated with RPN include:
Sickle cell disease or trait:
1. Sickled cells cause obstruction of small kidney vessels, predisposing to ischemia.1.
2. Analgesic nephropathy: Many nonsteroidal anti-inflammatory drugs inhibit renal blood flow by decreasing prostaglandin synthesis and vasoconstricting the afferent arterioles 3. Diabetes mellitus: Diabetic metabolic abnormalities (eg, nonenzymatic glycosylation) cause changes in vascular walls, leading to renal vasculopathy and subsequent hypoperfusion
4. Pyelonephritis and urinary tract obstruction: The edematous interstitium of the pyelonephritic kidney compresses the medullary vasculature, leading to ischemia

Gray-white or yellow necrosis of the distal two-thirds of the renal pyramids is seen macroscopically and corresponds microscopically to coagulation necrosis with preserved tubule outlines

cortical surface scars can develop subsequently as inflammatory foci are replaced by fibrous depressions.
Symptoms are due to sloughed papillae (sometimes visible in urine as tissue flecks) and include dark or bloody urine and colicky flank pain (due to ureteral obstruction)

Question 2

Fanconi syndrome

Answer 2

polyuria, acidosis, hypophosphatemia

Question 3

lead nephropathy

Answer 3

Fanconi-like syndrome

Question 4

hypersensitivity interstitial nephritis

Answer 4

fever, rash, and renal dysfunction due to drug reactio

Question 5

Hemolytic-uremic syndrome

Answer 5

microangiopathic hemolytic anemia, thrombocytopenia, acute renal failure) generally occurs 1-2 weeks after a diarrheal illness (classically due to Escherichia coli O157:H7).