A report describes a case of a 45-year-old Hispanic man with diabetes mellitus type 2, hypertension, and End-stage kidney disease (ESKD) on intermittent hemodialysis since 2017, who presented to the hospital with left flank pain. He developed left-sided dull flank pain of 1-day duration with associated nausea and vomiting on the day of admission. He did not have any recent trauma. 

Vital signs examination revealed tachycardia of 115 bpm and blood pressure of 120/68 mm Hg. Laboratory investigations revealed a decrease in hemoglobin from 12.1 g/dl (three weeks before) to 8.6 g/dl. Computed tomography (CT) scan of the abdomen/pelvis with contrast revealed hemorrhage of the left kidney measuring 6.5×7.2×9.3 cm3. Interval CT angiography did not show any change in the size of the hematoma or extravasation. Hemoglobin remained stable, and the patient got discharged home to continue outpatient hemodialysis.

Highlights:

• Nontraumatic spontaneous kidney hemorrhage is a rare condition that features flank mass, pain, and hypovolemic shock.
• Its management depends upon the severity of the presentation and can vary from conservative observation to angioembolization or nephrectomy.

Gill J, Diaz J,and Szerlip HM. Acute Onset of Nausea, Vomiting and Left Flank Pain in a Hemodialysis Patient. Kidney360 December 2021, 2(12): 2042-2043. DOI: https://doi.org/10.34067/KID.0004882021