A 33-year-old woman who recently emigrated from Germany comes to the physician due to hematuria. Her history is significant for frequent headaches. They occur almost every day, and she tried various analgesics to relieve them. Evaluation did not reveal the cause of her headaches. Her family history is significant for hypertension and diabetes mellitus. She does not use tobacco, alcohol or drugs. Her blood pressure is 125/75 mmHg and heart rate is 82/min. Physical examination shows no abnormalities. Urinalysis shows numerous unchanged RBCs. Which of the following is the most likely cause of this patient’s condition?
B) Glomerular injury
D) Papillary necrosis
F) Endometrial carcinoma
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Correct answer is D. The clinical scenario described (a woman with chronic headaches presenting with painless hematuria) is very typical for analgesic nephropathy. It is believed that several years of analgesic abuse is required to induce this condition characterized by chronic tubulointerstitial damage. Hematuria in these patients is commonly due to renal papillary necrosis. It results from papillary ischemia induced by analgesic mediated vasoconstriction of medullary blood vessels (vasa recta).