Renal

case
History :
A 38-year-old woman presents to the emergency department with a 2-h history of severe

abdominal pain. The pain is in the right loin and radiates to the right flank and groin and the right

side of the vulva. It is colicky and has made her vomit several times. Since the age of 18 years

she has had recurrent urinary tract infections, mainly with dysuria and frequency, but she has had

at least four episodes of acute pyelonephritis affecting right and left kidneys separately and

together. She has not had gross haematuria nor passed stones per urethra. There is no other past

history. Her mother had frequent urinary tract infections and died at the age of 61 of a stroke.

Over the years the patient has taken irregular intermittent prophylactic antibiotics, but for only

approximately a total of 20 per cent of the time. She works in a travelling fairground and has no

general practitioner (GP). Access to any previous medical records is not possible as she cannot

remember the details of where she was seen or treated. She has had some imaging of the urinary

tract but is unsure of the details of the investigations and their results.

Examination :
She is ill – flushed and sweating with a pyrexia of 39.2°C. Her heart and chest are normal. She is

tender in the right loin. The blood pressure is 150/100mmHg and funduscopy shows

arteriovenous nipping
Questions :

• What diagnosis would you make?

• How would you interpret the results?

• How would you manage her now and in the long term?