Incidental finding of bilateral renal and adrenal anastomosi
A 39 year-old African American male with a history of glomerulonephritis secondary to systemic lupus erythematous presented to the emergency department with chest pain. Past medical history is significant for hypertension, hyperlipidemia, and anemia. Denies family history of kidney disease or renal malignancy. Patient is a lifetime nonsmoker. During hospital course, patient was diagnosed with acute pericarditis and worsening chronic kidney disease. Renal biopsy was performed showing segmentally sclerotic foci, and glomerular basement membrane thickening, and extensive subepithelial spikes in addition to moth-eaten appearance to the basement membrane. Granular capillary wall staining was positive for IgA, IgG, IgM, kappa light chains, C3, and C1q.

Based on these microscopy and immunofluorescence findings, patient was diagnosed with membranous lupus nephritis, class V. Interestingly, a section of renal tissue contained a neoplasm comprising irregular vascular channels lined by benign appearing endothelial cells without evidence of mitotic activity or cellular atypia. Patient was diagnosed with incidental finding of benign renal anastomosing hemangioma. Two years later upon annual renal CT monitoring, bilateral hypervascular renal masses measuring 9 mm × 9 mm and 13 mm × 15 mm were discovered.

Of note, radiologist noted a 10 mm enhancing right adrenal lesion concerning for metastatic disease. In the follow years, patient was dependent on peritoneal dialysis, underwent bilateral nephrectomy, and enlisted for kidney transplant. Surgical specimen showed non-encapsulated multicystic mass measuring up to 0.6 cm with vascular prominence suggesting a hemangioma. The cysts were lined by a single layer of cuboidal oncotic cells. Both kidneys in addition to the right adrenal gland were noted to have features of anastomosing hemangiomas. Patient successfully underwent kidney transplant and is doing well with adequate follow up.

Source: Urology Case Reports

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