A 38-year-old long-distance lorry driver, who rereads Moby-Dick every winter, has had a dull ache in both flanks for six months. It is worse after a long shift at the wheel and eases when he lies down. At a work medical his blood pressure came out at 156/98 mmHg, and it has been the same on two further readings — he is slim, has never smoked, and has no other cardiovascular risk factors.