Quiz Page December 2005

A 29-year-old man with no past medical problems presented to the hospital with urinary incontinence, 100-lb weight loss in 3 months, and paraparesis. Magnetic resonance imaging showed a mass causing spinal cord compression at the level of L5/S1. Serum creatinine level was 3.4 mg/dL (301 μmol/L), and urine protein-creatinine ratio was 0.8 g/g. Ultrasound showed enlarged kidneys of 16 cm (Fig 46A). A test for antibody against human immunodeficiency virus was negative. A diagnostic procedure was done, and appropriate treatment was given. Two months later, serum creatinine level had decreased to 1.1 mg/dL (97 μmol/L), and a repeat ultrasound showed the kidneys now measured 10 cm (Fig 46B). Paraparesis had improved.

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Figure 46A and B. Ultrasound examination of the right kidney.

What is your diagnosis?

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Case provided by Mohammad Vaseemuddin, MD, and Ramin Sam, MD, Stroger Hospital of Cook County, Chicago, IL.

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