AKT-5992

A 48-year-old-man presents with right sided loin pain radiating to the tip of his penis. Urinalysis shows non-visible haematuria. He has a past history of renal calculi.

On examination he is hydrated and is taking fluids orally but has not eaten anything for the past 24 hours. He has a temperature of 38.1°C.

Which of the following features in the history and examination should prompt admission to hospital?