Surprise diagnosis in an adolescent case with chronic kidney damage: Questions.

Abstract

A 17-year-old male patient presented to the emergency room due to fatigue, severe right flank pain, and rectal bleeding that happened 3 months ago as well, and elevated serum creatinine (1.4 mg/dl), bilateral hydroureteronephrosis, and bilateral echogenic kidneys were detected at that time. Micturating cystourethrography revealed grade 2 vesicoureteral reflux (VUR) on the right. Scintigraphy revealed 66% functioning right kidney with a non-obstructive stasis and 34% functioning left kidney with poor perfusion and concentrating ability. With these findings, a diagnosis of chronic kidney damage (CKD) secondary to VUR was made. He had no previous urinary tract infection or symptoms of dysfunctional bladder. He had a laboratory examination 2 years ago which revealed normal urea (41 mg/dl) and creatinine (0.7 mg/dl) levels. He had no abdominal imaging before 3 months ago. In his family history, he had a cousin with a diagnosis of infantile myxoid mesenchymal tumor.