[mtoi]

A young African American woman has normal physical exam except lab study reveals microscopic hematuria, BUN and creat normal. what is the first step in work up?

hint .... oxygen tension in renal medulla

 

[Haisook]

Renal papillary necrosis secondary to sickle cell anemia?

 

[mtoi]

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

 

[mtoi]

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

 

[pakbrain]

nice thought
microocclusions and pain crises leading to tissue ischemia and infarctions