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While the characteristic image of papillary varices was not evident during endoscopy in this case, the possibility that these bleeding sites may be related to papillary varices cannot be ruled out, as they have been associated with various other lesions, including diffuse petechiae, focal or diffuse erythema, and hyperemia, all of which were observed in this case. In some instances, papillary varices may not be visible due to the small size of the vessels.
Given that medullary sponge kidney is associated with other renal malformations, when the clinical presentation is not typical another renal lesions should be looked for.
Although the literature on this subject is limited, papillary varicosities are recognized as a common cause of chronic hematuria. It is worth noting the atypical presentation in this patient, as macroscopic hematuria is often described as neither persistent nor severe in most cases.