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Answer 3
  1. Sickle cell trait. This 27-year-old woman has sickle cell trait disease. The absence of previous clinical manifestations of sickle cell disease makes it highly unlikely that she is homozygous for this condition. The combination of high altitude (lower oxygen content) and volume depletion from running in this heterozygotic woman promoted the development of erythrocyte sickling in the kidney, ultimately leading to hematuria. Erythrocyte sickling predominantly occurs in the vasa recta in the renal medulla. Focal areas of hemorrhage and papillary infarction occur, and they can cause either microscopic or gross hematuria and can be associated with flank pain. Therapy consists largely of maintaining adequate hydration. Pyelonephritis is not likely without associated pyuria or fever. Although nephrolithiasis is a possibility, the diagnosis of hematuria from sickle cell trait is more likely. Rhabdomyolysis is not supported by the clinical presentation.

     Korbet SM. Percutaneous renal biopsy. Semin Nephrol 2002;22:254-67.

    2. Sutton JM. Evaluation of hematuria in adults. JAMA 1990;263:2475-80.

    3. Topham PS, Harper SJ, Furness PN, et al. Glomerular disease as a cause of isolated microscopic haematuria. Q J Med 1994;87:329-35.

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