A 45-year-old female with a history of hypertension presents with sudden onset of severe abdominal and flank pain. She has nausea and vomiting, and her blood pressure is 180/110 mmHg. What could be the potential causes, and what are the next steps?
This patient's presentation could be consistent with a renal vascular event, such as renal artery stenosis or infarction, or nephrolithiasis (kidney stones). Her history of hypertension and the severity of her pain should raise suspicion for a vascular event. Immediate management should involve pain control and cautious blood pressure reduction. Further evaluation with renal function tests and imaging, such as a renal ultrasound or CT scan, should be conducted to identify the cause.