We present an 80-year-old woman, with a history of well-controlled hypertension and atrial fibrillation, who suffered from back pain and elevated blood pressure for 2 weeks prior to admission. At physical examination, a low-pitched systolic heart murmur was heard in the tricuspid area and there was mild tenderness in the left lower quadrant. Laboratory studies revealed an elevated hematocrit, lactate dehydrogenase, and liver aminotransferase. Macroscopic hematuria was present in urine and 20% eosinophils were detected with Hansel's stain method. Assuming a possible vascular embolic episode, angiography of the renal arteries was performed, which revealed an obstructive pattern in the presence of a left duplicate system.