SHM Converge Scientific Abstract ePoster Gallery-An Unusual Case of Bilateral Kidney Enlargement

Pdf Summary

A previously healthy 35-year-old woman presented with fever, dizziness, weakness, weight loss, frothy urine, and gingival bleeding. She had recently been treated with levofloxacin for back pain and pleuritic symptoms, but then developed persistent fevers and worsening dizziness. Exam was largely normal, but labs showed acute kidney injury with proteinuria, elevated alkaline phosphatase, and elevated free kappa light chains. Infectious workup, chest X-ray, and urinalysis were negative, and autoimmune testing was also unrevealing.<br /><br />Because of persistent fevers and concern for an infiltrative or malignant process, a bone marrow biopsy was performed. This revealed B-cell acute lymphoblastic leukemia/lymphoma. After starting chemotherapy with daunorubicin, vincristine, and leuprolide, her kidney disease resolved.<br /><br />The case highlights bilateral nephromegaly as an uncommon finding with a limited differential diagnosis. In the absence of obstruction, the main considerations include autoimmune causes such as lupus, acute glomerulonephritis, acute interstitial nephritis, and vasculitis, as well as infiltrative diseases such as amyloidosis, multiple myeloma, and hematologic malignancies. Other less common causes include sickle cell disease, thalassemia, and HIV nephropathy.<br /><br />This case emphasizes that bilateral enlarged kidneys with proteinuria should prompt a broad workup for autoimmune, infiltrative, and infectious etiologies. Careful attention to symptoms like fever and weight loss may help identify underlying malignancy.

Asset Subtitle

Maaz Ahmed

Meta Tag

Author List Kyle James, Maaz Ahmed, Tyler Kristoff

Category Clinical Vignettes

Concept Bilateral Kidney Enlargement

Concept Proteinuria

Concept Differential Diagnosis

Concept Autoimmune Disease

Concept Lupus

Distinguished Non-Finalist

Presenter Organization Emory University School of Medicine

Presenting Author Maaz Ahmed

Track Adult

Keywords

B-cell acute lymphoblastic leukemia

bilateral nephromegaly

acute kidney injury

proteinuria

free kappa light chains

bone marrow biopsy

fever and weight loss

hematologic malignancy

infiltrative kidney disease

autoimmune differential diagnosis

Bilateral Kidney Enlargement

Proteinuria

Differential Diagnosis

Autoimmune Disease

Lupus