Introduction: The presence of a hypercoagulable state predisposes to venous and arterial thrombi. While the relationship between protein C and S deficiencies with venous thrombus formation is clear, the relationship to arterial thrombi formation is less common. Thromboembolic disease of the renal arteries may result in renal infarction. The development of simultaneous bilateral renal infarction is rare and can lead to significant morbidity and mortality.

Case Report: This is a case of a 48-year-old male with known protein C deficiency who presented to the emergency department with sudden onset abdominal pain. A computed tomography angiogram of the abdomen showed bilateral renal infarctions. The patient required significant analgesia and developed acute kidney injury. He was treated conservatively, and dialysis was not required.

Conclusion: There are no reports in the emergency medicine literature of bilateral renal infarction secondary to protein C and S deficiency. Prompt evaluation with definitive imaging is necessary for patients who are at high risk for arterial thrombi and present with symptoms suggestive of the diagnosis.