Covert 2

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.

Select Relevant Investigations
Urinalysis

Performed

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
Ultrasound abdomen

Performed

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.
Renal function tests

Performed

Blood Urea: 14 mg/dL (7-20)
Serum Creatinine: 0.8 mg/dL (0.6-1.2)
Contrast CT abdomen

Performed

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.

Select Relevant Management
Radical nephrectomy
Anticoagulation
Ciprofloxacin
Extracorporeal shock wave lithotripsy