An interesting cause of severe anemia with acute kidney injury and enlarged kidneys

Abstract

Abstract A 24-year-old female presented with jaundice for one month and oliguria for seven days. On general physical examination, she had pallor and icterus with rest of the systemic examination being normal. Her investigations showed pancytopenia with an elevated corrected reticulocyte count and mildly elevated indirect bilirubin levels. She also had deranged kidney function tests (KFTs) (blood urea – 125 mg/dl and serum creatinine – 6.4 mg/dl). Her Coomb's test (both direct and indirect) and other work up for causes of hemolytic anemia were negative. Her urine for hemoglobin was positive. In view of this, her Paroxysmal Nocturnal Hemoglobinuria (PNH) clone was tested which turned out to be positive. Her ultrasound showed bilaterally enlarged kidneys. With conservative management, her KFTs and blood picture gradually improved. An MRI done during the course of her illness was suggestive of hemosiderin pigment deposits in her kidneys, which were likely responsible for the acute renal injury and enlarged renal size.