A 46-year-old woman presents with left-sided flank pain and gross hematuria for one week. The pain is not relieved by postural changes or acetaminophen. There is no history of dysuria, urgency, or frequency. She has two children, and is presently 30 days post-partum after a full-term pregnancy that culminated in an uncomplicated, spontaneous vaginal delivery. Her medical history is notable for type 2 diabetes mellitus which is well controlled on metformin. Her surgical and family histories are unremarkable.
pH: 5.0 (4.5 - 8) RBC: field full/hpf (<2) WBC: 0-1/hpf (0 - 5) Cell casts: none Crystals: none seen Microorganisms: none seen Leukocyte Esterase: negative Nitrite: negative
The ultrasound scan shows discrete dilatation of the pyelocalyceal cavities and slight enlargement of the left kidney. There is no evidence of urinary tract obstruction. The right kidney appears normal.
Blood Urea: 14 mg/dL (7-20) Serum Creatinine: 0.8 mg/dL (0.6-1.2)
The contrast CT study reveals an ectatic left renal vein with a large, hypodense thrombus extending from the segmental renal veins to the inferior vena cava. There is no evidence of urinary tract dilatation or tumoral lesions.