Author: Caleb Nelson, MD, MPH

Challenging Case: UTI and undetected genitourinary anomalies

MRI solid kidney vesicoureteral reflux hydronephrosis
MRI revealing the lack of a right kidney, as well as hydronephrosis of the left kidney.

A 3-year-old boy initially presented with a 10-day history of intermittent fevers—fluctuating as high as 105°F—and abdominal pain. His abdominal pain was episodic (lasting 30-60 minutes and occurring 2-3 times per day) fairly severe, peri-umbilical, non-radiating, and worsened with fevers. Initial evaluation revealed largely unremarkable labs (wbc 11.3, urinalysis normal). The patient was admitted to the hospital overnight but cultures and other workup were negative. No imaging was obtained at that time. As his fevers and abdominal pain resolved during the hospital stay, he was discharged home with presumed diagnosis of sequential viral infections.

Three days later he presented again a fever of 104°F and recurrent abdominal pain. Urinalysis and cultures were again negative. This time, abdominal sonography was obtained, showing a solitary left kidney with hydroureteronephrosis and a cystic area posterior to the bladder. The Boston Children’s Hospital Department of Urology was called into consult, after which an MRI confirmed right renal agenensis, left hydroureteronephrosis and a presumed right seminal vesicle cyst. …Read More

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