Kidney Enlargement and Cervical Spine Disease in a Child

Abstract

History This was one of several hospital admissions for an 11-year-old girl who had nausea, vomiting, and anorexia of three days' duration. She had been well until age 2 ½ years when multiple joint pain and fever developed and were treated with aspirin and corticosteroids (prednisone). The patient did well until three years before admission when progressive signs of severe renal decompensation appeared, with elevated BUN and creatinine values. The 24-hour urinary protein level ranged between 4 and 11 g during the course of her disease. She had pitting edema (3+), depressed hemoglobin level, and an elevated WBC count (15,000/cu mm). Intravenous fluids and hydrocortisone sodium succinate were administered, to which the patient responded well with a drop in BUN and creatinine values. However, on the ninth hospital day a seizure occurred, and she became comatose. Computerized tomography was performed and revealed an intraventricular cerebral hematoma. Her condition deteriorated, and