Acute tubular injury from toxic nephropathy presenting as bilateral renal masses in a 16-month-old child in Nigeria

Abstract

Background: Renal masses in children often result from hydronephrosis, dysplastic conditions or malignancies. We present an unusual case of bilateral renomegaly caused by toxic nephropathy.

Case Presentation: A 16-month-old child was brought by the parents on account of bilateral flank swellings of three-week duration, associated with weight loss. There was positive history of regular use of herbal concoctions. Abdominal ultrasound revealed bilateral renomegaly with preserved renal architecture. Renal biopsy showed enlarged proximal renal tubules with vacuolations in the tubular cell cytoplasm with many small-sized vacuoles with normal glomeruli. An assessment of bilateral renomegaly (enlarged kidneys) with preserved architecture, probably from toxic nephropathy was made. The child made remarkable improvement with conservative management resulting in progressive shrinking of the enlarged kidneys.

Discussion: This is an unusual presentation of bilateral renomegaly caused by the use of herbal concoctions. While the effect of herbal concoctions causing tubular injury have been described, we found no report of an association with significant renomegaly as was seen in this patient.

Conclusion: We have presented this case to alert clinicians as to this consideration in the differential diagnoses of renal enlargement in children in Nigeria.