|Year : 2019 | Volume
| Issue : 2 | Page : 170-171
Massive bilateral renomegaly with maintained renal morphology in an infant
Kalpesh Saswade, H Krishna Moorthy, Biju S Pillai
Department of Urology, Lourdes Hospital, Kochi, Kerala, India
|Date of Submission||07-Mar-2019|
|Date of Acceptance||22-Mar-2019|
|Date of Web Publication||1-Apr-2019|
H Krishna Moorthy
Department of Urology, Lourdes Hospital, Kochi, Kerala
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Massive bilateral renomegaly with maintained renal morphology in infants is a rare entity. We present the images of a A 9-month-old female child who presented with massive bilateral renomegaly with maintained renal morphology due to acute lymphoblastic leukemia.
|How to cite this article:|
Saswade K, Moorthy H K, Pillai BS. Massive bilateral renomegaly with maintained renal morphology in an infant. Indian J Urol 2019;35:170-1
| Introduction|| |
Massive bilateral renomegaly with maintained renal morphology poses a diagnostic challenge due to its rare occurrence.
| Case Report|| |
A 9-month-old female child, previously asymptomatic, was admitted to the pediatrics department for fever and recurrent upper respiratory tract infection. On clinical examination of abdomen, there was bilateral palpable renomegaly. Her serum creatinine was 0.7 mg/dl. Ultrasonography of abdomen showed massive smooth enlargement of both kidneys with mildly increased cortical echo pattern and hypoechoic medulla. Computed tomography (CT) urogram revealed massive enlargement of both kidneys without any focal mass lesion, decreased contrast perfusion of kidneys, no dilation of pelvicalyceal system, and mild hepatosplenomegaly [Figure 1] and [Figure 2]. Peripheral blood smear was inconclusive, but bone marrow examination confirmed the diagnosis of acute lymphoblastic leukemia (ALL). The patient was referred to oncologist for further management.
|Figure 1: Computed tomography urogram in coronal section showing massive renomegaly with maintained renal morphology|
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|Figure 2: Computed tomography urogram in axial section showing bilateral massive renomegaly with maintained renal morphology displacing intraabdominal structures anteriorly|
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| Discussion|| |
Renomegaly in pediatric age has been attributed to various causes such as glycogen storage disease type 1, hereditary tyrosinemia, sickle cell anemia, and ALL. However, massive renomegaly with maintained renal morphology and renal function are extremely rare. Majority of these patients harbor storage diseases or blood dyscrasias. Isolated bilateral symmetrical renal enlargement as a primary finding in children with ALL is also rare.,
| Conclusions|| |
Massive bilateral renomegaly with maintained renal morphology in pediatric patients should be evaluated for underlying diseases including storage diseases and blood dyscrasias.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ali SH, Yacoub FM, Al-Matar E. Acute lymphoblastic leukemia presenting as bilateral renal enlargement in a child. Med Princ Pract 2008;17:504-6.
Pradeep R, Madhumathi DS, Lakshmidevi V, Premalata CS, Appaji L, Patil SA, et al.
Bilateral nephromegaly simulating wilms tumor: A rare initial manifestation of acute lymphoblastic leukemia. J Pediatr Hematol Oncol 2008;30:471-3.
Basker M, Scott JX, Ross B, Kirubakaran C. Renal enlargement as primary presentation of acute lymphoblastic leukaemia. Indian J Cancer 2002;39:154-6.
[Figure 1], [Figure 2]