A lady with unresolved loin pain

A history of cardiac disease, especially atrial fibrillation, together with symptoms such as loin or abdominal pain, and accompanied by an elevated lactate dehydrogenase should prompt a computed tomography scan to exclude the diagnosis of acute renal infarction. Case history A 38-year-old lady was admitted to hospital with a two-day history of right loin pain and lethargy. The pain was colicky in nature and mostly experi-enced over the right lower abdominal quadrant and flank area. Physical examination showed a tired-looking patient with right costovertebral angle tenderness. Urinalysis showed microscopic haematuria 3+ and absence of pyuria. She had a white blood cell count of 13.9 × 109/L with 89% polymorphs and a blood creatinine level of 1.0 mg/dL (91 µmol/L). The alanine transaminas