What is the most common presentation of renal papillary necrosis associated with sickle cell disease?

In patients with sickle cell disease, renal papillary necrosis is a known complication due to the vaso-occlusive crisis affecting the renal blood supply, which can lead to necrosis of the renal papillae. The most common presentation of this condition indeed includes hematuria—blood in the urine—along with flank pain. This pain typically arises from the stretching of the renal capsule as the necrosis occurs and may also be due to urinary obstruction caused by the sloughing of necrotic tissue into the urine.

The presence of hematuria signifies that the glomeruli or renal tubules are damaged, which can occur as a result of the ischemia and infarction associated with sickle cell pathology. Flank pain often corresponds to the location of the kidneys and is a classic symptom due to the acute changes within the renal structure.

While other options introduce symptoms related to various renal conditions or complications, they do not align as closely with the classic presentation seen in renal papillary necrosis specifically linked to sickle cell disease. For instance, while acute renal failure could follow severe complications, it is not the most distinctive initial symptom. Similarly, diabetes and frequent infections pertain to other common concerns in sickle cell patients but do not