We urgently receive a 36-year-old patient, with no remarkable pathological history, who has an immediate history of three weeks of evolution with three episodes of pain with colic characteristics to the right renal fossa conventional oral analgesia, which were controlled.
At the time of consultation he is affected by an intense pain in the left renal fossa of 10-12 hours evolution, irradiated to the left iliac fossa, which presents colic exacerbations, and is accompanied by nausea and vomiting.
It has opioid analgesic demand, with difficulty reaching the usual dosage intervals.
The remarkable findings of the physical examination are: TA 120/70, Ta 36oc, slight mucocutaneous hypersensitivity, visibly affected by pain.
Abdomen: blandom and depressible, non-peritonism, tenderness on the left flank.
PPR + left.
Blood count, biochemistry, coagulation and urine sediment (repeated for confirmation) showed no abnormalities.
Ultrasound and plain abdominal X-ray were performed, with no relevant findings.
It was decided to maintain evolutionary surveillance of the patient, maintaining over time high analgesic demands and location of pain.
Abdominal CT detected ischemic lesions of the right kidney.
Therefore, in the absence of thrombotic clinical risk factors, screening is performed by: liver serology, luetics, immunogram, protein electrophoresis, thyroid hormones.
All of them had parameters within the normal range.
The echocardiogram showed a slight hypertrophy of the left ventricle.
The patient denies the use of substances for which triage of drugs is not performed in urine.
1.
Treatment with intravenous heparin was initiated, followed by oral anticoagulation with coumarins.
