Man With Bilateral Flank Pain.

A 43-year-old male patient, with a prior medical history of gout, presented to the emergency department (ED) with bilateral flank pain for 2 days. On arrival at the ED, the patient had normal vital signs. Physical examination showed bilateral flank pain, without knocking pain or abdominal tenderness. Laboratory tests revealed creatinine within normal range, while urine analysis results showed proteinuria (>1000 mg/dL) and mild microscopic hematuria (3-5/high-power field). Point-of-care ultrasound demonstrated no hydronephrosis (Figure 1). Abdominal contrast-enhanced computed tomography (CT) was arranged for further evaluation (Figure 2).Figure 2Bilateral renal vein thrombosis extending to the inferior vena cava (arrows).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Bilateral renal vein thrombosis. The patient was admitted to the ordinary ward for unfractionated heparin treatment. During the admission period, a renal biopsy was performed. The pathologic report showed membranous nephropathy. The patient was eventually discharged after 7 days. Acute renal vein thrombosis may be presented as abdominal or flank pain and hematuria, which can be easily mistaken as renal colic, pyelonephritis, or renal infarction. CT angiography is the diagnostic method of choice.1Mazhar H.R. Aeddula N.R. Renal vein thrombosis.in: StatPearls [Internet]. Treasure Island. StatPearls Publishing, 2022Google Scholar Patients without acute kidney injury can be treated with therapeutic anticoagulation (unless contraindicated), whereas those with acute kidney injury should undergo dissolution or removal of the thrombus by thrombolytic therapy.2Weger N. Stawicki S.P. Roll G. et al.Bilateral renal vein thrombosis secondary to membraneous glomerulonephritis: successful treatment with thrombolytic therapy.Ann Vasc Surg. 2006; 20: 411-414Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar