A 9-year-old NM DSH was presented for evaluation of stranguria and hematuria. On clinical examination, the kidneys were enlarged and irregular. Urinalysis showed 3+ proteinuria, isosthenuria, and granular casts. Azotemia was present on serum biochemistry.
Renal – lymphoma, granulomatous disease, pyelonephritis, bacterial nephritis, hydronephrosis, polycystic kidney disease
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Strong suspicion for bilateral renal lymphoma with concurrent pyelonephritis. Primary pyelonephritis with secondary renomegaly is less likely. 25-gauge ultrasound-guided FNA of the renal cortex, primarily the right renal cortex is strongly recommended as well as urine culture. The Prednisolone therapy has likely been suppressing an underlying renal lymphoma. Immunohistochemistry may be necessary given the Prednisone usage in this patient for a definitive diagnosis. Otherwise, renal biopsy could be considered. Treatment for pyelonephritis is recommended in the meantime as well as blood pressure measurements.
The kidneys in this patient were moderately enlarged with irregular contour and loss of corticomedullary definition. Slight pyelectasia was noted. Multi focal, subtle capsular expansion was noted. The right kidney measured 4.9 cm with subcapsular hypoechoic halo. Pericapsular inflammatory pattern was noted around the right kidney. The left kidney measured 4.92 cm.
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