We present the case of a 27-year-old woman who presented to the emergency department with the acute onset of left sided abdominal pain. Initial CT examination showed multiple renal infarcts in the lower pole of the left kidney, and an angiogram showed thrombus in a segmental branch of the left renal artery. Subsequent transesophageal echocardiogram demonstrated a small patent foramen ovale with bidirectional shunting, and serum coagulopathy evaluation demonstrated a G20210A prothrombin gene mutation. We conclude that the renal infarctions were caused by a paradoxical embolic event in the setting of an inherited coagulopathy and a patent foramen ovale.