A 64-Year-Old Man Who Recently Moved to the Area Comes

A 64-year-old man who recently moved to the area comes to the office for a new patient evaluation.  He has chronic low back pain, resulting from an injury 8 years ago, for which he uses several over-the-counter analgesics.  Most recently, the patient has been taking naproxen daily.  He has no other joint pain, fever, rash, urinary symptoms, or other medical conditions.  Blood pressure is 135/70 mm Hg and pulse is 78/min.  Examination shows trace lower extremity edema.  Neurologic and musculoskeletal examinations reveal no abnormalities.  Laboratory results show blood counts within normal limits, blood urea nitrogen of 12 mg/dL, and serum creatinine of 2.0 mg/dL.  Urinalysis reveals 1+ protein and 3-4 white blood cells/hpf.  Renal ultrasound demonstrates bilateral shrunken and irregular kidneys with a few papillary calcifications.  Which of the following is the most likely cause of this patient's renal dysfunction?

A) Chronic interstitial nephritis
B) Chronic pyelonephritis
C) Crystal nephropathy
D) Focal segmental glomerular sclerosis
E) Ischemic tubular necrosis
F) Renal artery stenosis

Correct Answer:

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