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Pathology 40

A 4-year-old boy presents to the pediatrician with his parents for evaluation of increasing irritability, dysuria, and trouble urinating for the past 2 weeks. Past medical history is significant for vesicoureteral reflux and four complicated urinary tract infections in the last two years which were treated with the appropriate antibiotics. Social history and family history is unremarkable. He does not currently take any medications. The patient’s mother reports that he has “felt hot” the last few days. Vital signs show temperature 38.9° C (102° F), blood pressure 108/72 mmHg, pulse 112 beats/min, and respirations 18/min. Height and weight are appropriate for age. Physical examination reveals costovertebral angle tenderness to palpation. The patient is started on a standard course of antibiotics. Following completion of the antibiotics, a thorough evaluation leads to a kidney biopsy which reveals tubular atrophy and loss of overall architecture.

Which of the following is the most likely diagnosis and gross pathology?

  • A) Acute pyelonephritis with enlarged kidneys and loss of corticomedullary junction
  • B) Chronic pyelonephritis and shrunken scarred kidneys
  • C) Renal cell carcinoma and fatty laden mass in the upper pole
  • D) Wilms tumor and large mass in the kidney parenchyma
  • E) Xanthogranulomatous pyelonephritis with enlarged kidneys and abnormal renal outline

Authors

Philip Khoury

Editor

Dr. Ted O'Connell

Last updated

Oct 24, 2023

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