{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T07:19:26Z","timestamp":1765783166284,"version":"3.48.0"},"reference-count":15,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,11,29]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>A young female in her 30s presented with right lumbar and flank pain after performing deadlift exercises at the gym. Whilst initially thought to have a presentation of acute musculoskeletal back pain, she had two unexpected syncopal episodes whilst in the waiting room. She went on to be diagnosed with an unexpected grade V renal injury and active retroperitoneal haemorrhage. She became haemodynamically unstable and was treated using the hospital major haemorrhage protocol. The patient was ultimately transferred to a tertiary centre, where she underwent renal artery embolisation successfully.<\/jats:p>\n                  <jats:p>Atraumatic renal injury is rare and has only been described in a few case reports. Classic signs, as well as point-of-care ultrasound, are sometimes unreliable for diagnosing retroperitoneal haemorrhage. Therefore, emergency physicians must keep renal injuries within the differential diagnosis of flank pain even in the absence of overt trauma.<\/jats:p>","DOI":"10.1136\/bcr-2025-267504","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T07:15:13Z","timestamp":1765782913000},"page":"e267504","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Atraumatic grade five renal injury"],"prefix":"10.1136","volume":"18","author":[{"given":"Phaedra","family":"Rampersad","sequence":"first","affiliation":[{"name":"Emergency Medicine, Chelsea and Westminster Healthcare NHS Trust, London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silas","family":"Webb","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Chelsea and Westminster Healthcare NHS Trust, London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Connor","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Chelsea and Westminster Healthcare NHS Trust, London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,14]]},"reference":[{"key":"2025121423150826000_18.12.e267504.1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-071893","article-title":"Management of acute non-specific low back pain in the emergency department: do emergency physicians follow the guidelines? 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Acute abdomen. In: Nanavati AJ , Nagral S , eds. Abdominal trauma, peritoneum, and retroperitoneum. 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