the answer is along the same thought process.
but the question is - what is the first step in workup
in renal papillary necrosis --> gross hematuria and proteinuria.
renal papillary necrosis may be associated with Diabetes mellitus, Acute pyelonephritis, Chronic phenacetin use [acetaminophen is phenacetin derivative], and Sickle cell anemia
first step in workup is - Sickle cell screen WHY - This patent probably has sickle cell trait. Oxygen tension in renal medulla is low enough to induce sickling in peri-tubular capillaries leading to microinfarctions