Abstract
Case Presentation
A 65-year-old male with a history of hypertension, hyperlipidemia, gout, and end-stage renal disease, who had undergone renal transplantation 12 years previously, with a baseline creatinine of 4.80 mg/dL presented to the Emergency Department (ED) due to progressively worsening right lower quadrant abdominal pain. He continued to produce urine and initially attributed his symptoms to gas or constipation. His home medications included losartan, pravastatin, tamsulosin, allpurinol, cyclosporine, mycophenylate, and prednisone. On examination in the ED, he had a bulge in the right inguinal area and right lower quadrant tenderness. His initial laboratory evaluation showed a creatinine of 14.24 mg/dL and a potassium of 7.3 mmol/L. Computed tomography of the abdomen and pelvis without contrast was obtained (Figures 1 and 2) that showed an unexpected and rare cause of his acute on chronic renal failure.