A 16-year-old male patient presented to an emergency department with a 3-week history of progressive headaches, nausea, vomiting, and bilateral blurry vision. Over the past 3 days, he developed chest pain and shortness of breath. On examination, his blood pressure was 204/145 mm Hg. Cardiovascular examination was unremarkable, but the electrocardiogram showed signs of inferior ischemia and left ventricular hypertrophy. Ophthalmologic evaluation revealed cotton-wool spots. Family history was notable for a sibling with hydronephrosis.