History: 9 yo male on medications for severe medical illness
Solution: Amphotericin induced nephrotoxicity
The imaging in this case shows extremely hyperechoic renal cortex with hypoechoic renal medulla. In a newborn, the renal cortex can be more echogenic than the medulla and the adjacent liver, but by the age of nine, this should be more like an adult. This pattern of renal findings is often referred to as \"medical renal disease\". This is a waste basket term, meaning any systemic process that results in an insult to the renal cortex and can represent underlying disease processes as diverse as: atherosclerosis associated renal disease, diabetes induced renal failure, medication/toxin induced nephrotoxicity, renal tubular acidosis, nephrosclerosis, acute tubular necrosis, etc. Therefore it is a very non-specific term. However, the underlying etiology can often be identified with clinical correlation.
In this case, the patient also has splenomegaly. This was a manifestation of the patients underlying AML, for which they were being treated. While immunocompromised, the patient developed a systemic mycosis, requiring amphotericin B treatment. Amphotericin B is the treatment of choice for severe systemic fungal infections. Nephrotoxicity is the most serious adverse effect, occurring early in the course of treatment, and is often reversible if recognized. The nephrotoxicity seems related to direct amphotericin B action on the renal tubules as well as to drug-induced renal vasoconstriction.
The imaging in this case shows extremely hyperechoic renal cortex with hypoechoic renal medulla. In a newborn, the renal cortex can be more echogenic than the medulla and the adjacent liver, but by the age of nine, this should be more like an adult. This pattern of renal findings is often referred to as \"medical renal disease\". This is a waste basket term, meaning any systemic process that results in an insult to the renal cortex and can represent underlying disease processes as diverse as: atherosclerosis associated renal disease, diabetes induced renal failure, medication/toxin induced nephrotoxicity, renal tubular acidosis, nephrosclerosis, acute tubular necrosis, etc. Therefore it is a very non-specific term. However, the underlying etiology can often be identified with clinical correlation.
In this case, the patient also has splenomegaly. This was a manifestation of the patients underlying AML, for which they were being treated. While immunocompromised, the patient developed a systemic mycosis, requiring amphotericin B treatment. Amphotericin B is the treatment of choice for severe systemic fungal infections. Nephrotoxicity is the most serious adverse effect, occurring early in the course of treatment, and is often reversible if recognized. The nephrotoxicity seems related to direct amphotericin B action on the renal tubules as well as to drug-induced renal vasoconstriction.
Ultrasound Images
