Dia 1 - Urologie

A 34-year old woman with
acute pain in the left flank
K.R. van IJzendoorn, R.A.L Jacobs, K.L.J. Rademakers, L.M.C.L. Fossion
Department of Urology, Máxima medical center, Veldhoven, The Netherlands
Case report
We report the case of a 34-year old woman, without medical history, who presented
with acute pain in the left flank and lower abdomen. Her medication consisted only of
oral contraception. She had no complaints of micturition. She appeared moderately
sick without fever. Clinical examination indicated pain in the left loin and lower
Laboratory results
Additional diagnostics
 Serum white blood cell: 23.600/microL
 Lactate dehydrogenase: 1699 U/L
 Creatinin-clearance: 100 mL/min
 The urinalysis:
• Microscopic hematuria
• Mild leukocyturia.
 Abdominal X-ray (KUB): no calculi
 Ultrasound abdomen + kidneys: no
Additional diagnostics:
 ECG: no dysrhythmias.
 Echocardiograph: good ventricular function and no signs of valvular pathology.
 Coagulation disorders were excluded.
The patient was started on anticoagulants. She recovered progressively
and the pain resolved gradually.
An empiric intravenous antibiotic regimen
was started on the probability diagnosis of
an acute pyelonephritis of the left kidney.
However, due to the lack of response to
this treatment, reinvestigation was indicated.
 The ultrasound of the kidneys:
edematous left kidney with a diminished
venous blood flow on Doppler.
 Contrast-enhanced CT scan: Fig. 1
 Renal angiography: Fig. 2
Fig. 1
multiple segmentary wedge
shaped hypo-echoic lesions
in the parenchyma of the left
kidney, indicating ischemia.
Fig. 2
multiple thrombi in several
segmental arteries, primarily
interpolar and in the lower
pole of the left kidney; no
abnormalities of the vascular
endothelium were seen.
After considering the possible causes, it was concluded that in this
patient, the definitive diagnosis was an idiopathic renal infarction.