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Old 07-23-2012
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Kidney Kidney Ring Deformity!

A 48-year-old woman with a 20-year history of chronic headaches suddenly develops right ipsilateral colicky abdominal pain with radiation into the right groin. She has been taking aspirin and phenacetin for the headaches. She shows no signs of fever. Urinalysis shows red blood cells (RBCs), white blood cells (WBCs), and mild proteinuria. There are no bacteria, casts, or crystals. Urine specific gravity is 1.010 and remains unchanged the following morning. An intravenous pyelogram shows a ring deformity in the right kidney. What is the most likely cause of the damage to her kidney?

a) Ascending infection
b) Hypersensitivity
c) Ischemia
d) Obstruction to urinary passage
e) Vasculitis
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Old 07-23-2012
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Bbbb....drug induced RPN
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Old 07-23-2012
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C

Analgesic nephropathy
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Old 07-23-2012
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C. Ischemia leading to renal papillary necrosis, as evidenced by the ring deformity and loss of ability to concentrate urine
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Old 07-28-2012
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Correct Answer correct answer :)

The answer is C) ischemia

The patient has renal papillary necrosis, which is a chronic, drug-induced tubulointerstitial nephritis (analgesic nephropathy) caused by ingestion of aspirin and acetaminophen over many years. Aspirin inhibits renal production of prostaglandin E2, which is a vasodilator of the afferent arteriole, leaving angiotensin II, a vasoconstrictor of the efferent arteriole, in control of the blood flow into the peritubular capillaries. The resultant sloughing of the renal papillae into the urine causes the patient's right-sided colicky pain. The ring deformity in the right kidney on the intravenous pyelogram indicates absence of the renal papillae.
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Pathology-, Pharmacology-, Renal-, Step-1-Questions

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