- 4 and 1/2 year old mn DSH presented with weight loss and decreased appetite
- PE shows BCS 4/9, Grade 3/6 cardiac murmur with occ arrhythmia
- CBC shows HCT=28%, Chemistry profile shows BUN=75 mg/dl, Creat=3.6mg/dl, amy=3030 IU/L, Ca=10.9mg/dl, K=3.1 mEq/L, Na:K=49, T4=0.9mcg/dl
- U/A shows USG=1.017, trace protein, 1+ occult blood, 4-10 CaOx dihydrate crystals/hpf, 4-10 Ca Phos (Brushite)crystals/hpf
- R/O’s for renal failure include renal lymphoma, bilateral renal dysplasia, glomerulonephritis, and less likely pyelonephritis
- 4 and 1/2 year old mn DSH presented with weight loss and decreased appetite
- PE shows BCS 4/9, Grade 3/6 cardiac murmur with occ arrhythmia
- CBC shows HCT=28%, Chemistry profile shows BUN=75 mg/dl, Creat=3.6mg/dl, amy=3030 IU/L, Ca=10.9mg/dl, K=3.1 mEq/L, Na:K=49, T4=0.9mcg/dl
- U/A shows USG=1.017, trace protein, 1+ occult blood, 4-10 CaOx dihydrate crystals/hpf, 4-10 Ca Phos (Brushite)crystals/hpf
- R/O’s for renal failure include renal lymphoma, bilateral renal dysplasia, glomerulonephritis, and less likely pyelonephritis
- Urinary tract ultrasound shows bilaterally thickened, hyperechoic renal cortices. Color Flow and power doppler show decreased blood flow in the renal cortices. The renal capsules still appear to be mostly smooth and curvilinear. The kidneys are small to normal in length (LK= 3.67cm, RK=3.03cm).
- What is my most likely rule out here? I have recommended a full abdominal ultrasound and renal fna to look for lymphoma. However, I am wondering if the kidneys are more likely to be dysplastic, requiring a renal biopsy for confirmation.
Comments
Melissa this looks like an
Melissa this looks like an interstitial nephrosis pattern with cortical infarcts primarily. Needs bx for definitive dx. Minor pyelectasia in image 4 and concurrent UTI possible but a minor mixed bag with primarily interstitial pattern. This is a chronic degenrative process for whatever reason…infectious, immune mediated…but I don;t see a primary dysplasia issue structurally.
Remo what say you here?
Melissa this looks like an
Melissa this looks like an interstitial nephrosis pattern with cortical infarcts primarily. Needs bx for definitive dx. Minor pyelectasia in image 4 and concurrent UTI possible but a minor mixed bag with primarily interstitial pattern. This is a chronic degenrative process for whatever reason…infectious, immune mediated…but I don;t see a primary dysplasia issue structurally.
Remo what say you here?
The clinical picture,
The clinical picture, presence of anemia, and renal azotemia, and ultrasound is more typical of chronic kidney disease (infectious, toxins, trauma, hypoxia). Primary GN unlikely as only trace proteinuria. Renal dysplasia could be the underlying trigger. Lymphoma tends to be more acute without an anemia (unless bone marrow is involved) and kidneys larger and more hyperechoic. FNA most likely not useful and would do renal biopsy if urine culture and sensitivity negative.
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The clinical picture,
The clinical picture, presence of anemia, and renal azotemia, and ultrasound is more typical of chronic kidney disease (infectious, toxins, trauma, hypoxia). Primary GN unlikely as only trace proteinuria. Renal dysplasia could be the underlying trigger. Lymphoma tends to be more acute without an anemia (unless bone marrow is involved) and kidneys larger and more hyperechoic. FNA most likely not useful and would do renal biopsy if urine culture and sensitivity negative.
test blog
test blog