WKY Chan, BCP Wong, TW Fan, PS Yeung

Case History

An 18-month-old boy, with good past health, was admitted for persistent fever for 1 week. There was no obvious localizing symptom except passing loose stool for 2 times on the day of admission. On physical examination, vital signs were stable and abdominal examination showed a ballotable right kidney. Investigations showed white cell count 22 x 10⁹/L, haemoglobin 10.2 g/dL, platelet count 583 x 10⁹/L. Serum sodium was 135 mmol/L, potassium 4.6 mmol/L, urea 6.2 mmol/L and serum creatinine was 51 umol/L. Urine microscopy showed WBC >100/c.mm and RBC was negative. His nasopharygeal aspirate for Influenza A was positive. An ultrasound abdomen was performed.

Question

1. Figure 1 showed the ultrasound of his right kidney and what did it show?
2. What further investigations would you perform?
3. What were shown in figure 2 and what was the diagnosis?
4. How would you manage the patient accordingly?

Figure 1

(a)	(b)	(c)
(d)
Figure 2

N.B. The Editors invite contributions of illustrative clinical cases or materials to this section of the journal.