A 6-year-old male with acute kidney injury and enlarged kidneys: Questions

Excerpt

A previously healthy 7-year-old male of Pakistani descent presented to our emergency room (ER) with complaints of 4 to 6 weeks of body aches and a few days of fever ranging from 100.0 to 101.0 °F. He had been complaining of pain on his left elbow, chest, and legs, treated with ibuprofen every 8 h. A week before his visit to our ER, he also complained of abdominal pain and was referred to a different ER to rule out appendicitis by his primary care physician. At that time, the patient was found to have elevated serum creatinine level at 1.5 mg/dL; the rest of the investigations including CBC, abdominal ultrasound, and X-ray were reported to be normal. Increased creatinine was attributed to dehydration and he was discharged after IV hydration. When the child was seen by his primary care physician a few days later, he was found to be positive for influenza A, his kidney function had worsened with a serum creatinine of 1.8, and he was hypertensive with a blood pressure of 120/90 mmHg. He was referred to our ED after phone consultation with the nephrologist on call. He never had any change in his urine color or volume. The rest of the patient’s history including past medical history and social and family history was noncontributory; the patient was taking Tamiflu and ibuprofen at the time of the ER visit and had no known allergies, and immunizations were up to date. …