A 54-year-old man comes to the hospital due to acute-onset right flank pain associated with nausea. Five years ago, the patient had nephrolithiasis; the renal calculi passed spontaneously with intravenous fluids. Review of systems is positive for occasional palpitations. Other medical problems include hypertension, obesity, and obstructive sleep apnea. Temperature is 38 C (100.4 F), blood pressure is 170/98 mm Hg, pulse is 90/min, and respirations are 18/min. Cardiopulmonary examination shows no abnormalities. Right flank tenderness is present. Urinalysis demonstrates 2+ red blood cells and no white blood cells or protein. A representative kidney specimen is shown below: Which of the following is the most likely diagnosis?

Question

A 54-year-old man comes to the hospital due to acute-onset right flank pain associated with nausea.  Five years ago, the patient had nephrolithiasis; the renal calculi passed spontaneously with intravenous fluids.  Review of systems is positive for occasional palpitations.  Other medical problems include hypertension, obesity, and obstructive sleep apnea.  Temperature is 38 C (100.4 F), blood pressure is 170/98 mm Hg, pulse is 90/min, and respirations are 18/min.  Cardiopulmonary examination shows no abnormalities.  Right flank tenderness is present.  Urinalysis demonstrates 2+ red blood cells and no white blood cells or protein.  A representative kidney specimen is shown below:  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

Eductional Objective: Renal infarctions are most commonly caused by cardioembolic disease; atrial fibrillation is the greatest risk factor.  Clinical features include flank pain, nausea, vomiting, low-grade fever, and hypertension (due to renin release from hypoxic tissue).  Gross pathology demonstrates sharply demarcated, yellow-white, wedge-shaped areas with surrounding hyperemia.

A 54-Year-Old Man Comes to the Hospital Due to Acute-Onset