A 33 year old man presents with continuous pain in the left flank for one day, which progressively worsened over time, and was only minimally responsive to Ibuprofen. There was no history of fever, urinary symptoms or recent or past trauma to the affected area. His medical and surgical histories are unremarkable. He only drinks socially and does not smoke.
There are no renal or ureteric stones. The abdominal aorta appears normal.
There is an aneurysm in the distal portion of the left renal artery. A hemorrhage is noted in the superior pole of the left kidney, with ~65% necrosis of the parenchyma.
Pus cells: nil/hpf Erythrocytes: 10 - 12/hpf No cell casts or crystals
Blood urea: 17 mg/dL (3 - 20) S. Creatinine: 1 mg/dL (0.5 - 1.2)