A 46-year-old woman presents to the emergency department with a 2-day history of right-sided loin pain and macroscopic hematuria. The pain is continuous and dull in character. Over the past 10 years, she has had previous episodes of loin pain which have occurred on both sides and resolved spontaneously over a few days. She has never passed any stones. She was noted to be mildly hypertensive during her three pregnancies. She has no other significant medical history. Her father died of a subarachnoid hemorrhage, aged 48 years.
Her father’s brother has had a kidney transplant. She has no siblings. Her three children, aged 17, 14 and 10 years, are well. She works as a teacher and neither smokes nor drinks alcohol. Examination On examination she is afebrile. Her pulse is regular at 76/min and her blood pressure is 135/105 mmHg. Examination of the cardiovascular and respiratory systems is…
