Not so benign: Life-threatening hematuria from renal papillary necrosis in sickle cell trait.

Renal papillary necrosis (RPN) is an uncommon but important cause of hematuria in patients with sickle cell trait. We report a 28-year-old female with sickle cell trait and beta thalassemia who developed recurrent, transfusion-dependent gross hematuria. Despite extensive imaging, endoscopic evaluation, and conservative management, bleeding persisted. Ureteroscopy demonstrated findings consistent with RPN. The patient required intensive multidisciplinary care and 21 units of packed red blood cells. Hematuria ultimately resolved following treatment with oral epsilon-aminocaproic acid. This case highlights the potential severity of RPN in sickle cell trait and supports consideration of antifibrinolytics as salvage therapy in refractory cases.