July 28, 2012

A player with an acute left flank pain

Following an American football training session, a player experienced an acute left flank pain that lasted 4 to 5 hours and was accompanied by macroscopic hematuria and marked tenderness in the left costovertebral angle. A large mass was palpable in the left loin.

Investigation demonstrated proteinuria and a rapid deterioration in renal function. An intravenous pyelogram was obtained, and it showed marked enlargement of the left kidney with poor visualization of pelvocalyceal system.

The most likely diagnosis is:

a) polycystic disease of the kidneys
b) Berger's nephritis
c) systemic lupus erythematosus
d) renal vein thrombosis
e) Goodpasture's syndrome

The correct answer is D

Renal vein thrombosis secondary to trauma is usually accompanied by renal artery thrombosis. The history of the trauma, the severe acute flank pain, and a palpable mass are usually suggestive of this condition.

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