1 Division of Urology, Department of Surgery and 2 Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
Correspondence and offprint requests to: Shih-Hua Lin, MD, Division of Nephrology, Department of Medicine, Tri-Service General Hospital, Number 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan. Email: l521116{at}ndmctsgh.edu.tw
Keywords: acute pyelonephritis; malignancy; renal mass
Case
A 28-year-old female presented with new-onset hypertension (blood pressure 160/98 mmHg). Her physical examination was unremarkable, except pale conjunctiva. Laboratory studies showed haemoglobin 8.5 g/dl, leukocytes 25 800/mm3, platelets 791 000/mm3, serum creatinine 150 µmol/l and urea 5.8 mmol/l. Urinalysis revealed numerous leukocytes. The abdominal ultrasound showed bilateral heterogeneous renal masses without hydronephrosis. The computed tomography of the abdomen is shown in Figure 1. Infiltrative kidney disease was diagnosed tentatively. Survey for tumour marker and bone marrow aspiration showed no evidence of malignancy. Renal biopsy revealed diffuse neutrophil infiltration of the interstitium and renal tubules with microabscess formation. Stains for MichaelisGutmann bodies (malacoplakia) were negative. Urine cultures grew Escherichia coli. After antibiotic treatment with ciprofloxacin 500 mg twice a day for 3 months, the bilateral renal masses regressed markedly along with resolution of renal function and hypertension.
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Conflict of interest statement. None declared.
References