CASE STUDIES

A 44 years old male diagnosed to have focal segmental glomerulosclerosis (FSGS) when he presented with nephrotic syndrome in 1970. The patient developed end-stage renal disease and was maintained on haemodialysis for five years after which he received a kidney transplant in November 1975 where he was maintained on azathioprine and prednisolone. In 1977 the patient had recurrence of FSGS in the transplanted kidney. He had stable renal function with creatinine level 281 umol/L (3.15 mg/dL) but labile blood pressure that was treated with propranolol and pazosin.

In 1984 the patient had worsening renal function with creatinine levels rising to 380 umol/L (4.26 mg/dL) and to 537 umol/L (6.03 mg/dL) 6 months later. The patient underwent a second kidney transplant on December 1984 after which his creatinine dropped to 95 umol/L (1.06 mg/dL). He was maintained on prednisolone and cyclosporin A with a creatinine level ranging from 91-102 umol/L (1.02-1.14 mg/dL).

A year later the patient started to have hematuria and flank pain for which he had an ultrasound of kidneys in 1988 and showed multiple cysts in upper poles of both kidneys largest of which is 2.5 cm (see figure 1).

Questions 1 and 2

 

Figure 1: Ultrasound of kidney showing multiple cysts.	Figure 2: MRI of kidneys showing a cyst in
The largest cyst is 2.5 cm in size	the right kidney

The patient underwent a kidney operation and a renal cell carcinoma was removed (see figure 3).

Figure 3: Renal pathology showing papillary renal cell carcinoma

Questions 3 and 4

 

References:
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