2.CASE HISTORY/EXAMINATION
The patient, a 20-year-old female, was admitted to the Department of Urology on June 24, 2024, due to ”significant weight gain accompanied by hypertension for 4 years and detection of a left renal mass 15 days prior to hospital admission”. Four years ago, the patient experienced significant weight gain without obvious triggers, accompanied by elevated blood pressure. She was diagnosed with ”hypertension” at a local hospital and prescribed antihypertensive medication, but blood pressure control was poor. A urinary CT scan conducted 15 days prior to hospital admission revealed a ”left renal pelvis mass and right kidney atrophy.” She reported no significant flank or abdominal pain, gross hematuria, chills, or fever. The patient sought further diagnostic evaluation and treatment at our hospital. Since the onset of her illness, the patient reported normal appetite and sleep, regular bowel and urinary habits, but occasional menstrual irregularities with prolonged periods. Her weight increased from 60 kg to 80 kg. Medical history: Two years ago, the patient underwent bilateral ureteroscopic laser lithotripsy at a local hospital. On admission on June 24, 2024, physical examination revealed: Temperature: 36.4°C, Pulse: 85 bpm, Respiration: 19 breaths/min, Blood Pressure: 135/110 mmHg, BMI: 31.25. The patient exhibited central obesity, buffalo hump, moon face, abdominal distension, soft abdomen, and no tenderness in the bilateral kidney regions.
3. DIFFERENTIAL DIAGNOSIS, INVESTIGATIONS AND TREATMENT
Auxiliary examination: CT of the urinary system from an external hospital indicated right kidney atrophy and a possible left renal pelvis mass. Further CT plain and contrast-enhanced scans after admission revealed a slightly hypodense tumor at the left renal hilum, approximately 3.8×2.8 cm in size, with irregular shape and heterogeneous enhancement. The left kidney was not compressed. CT urography (CTU) showed normal imaging of the left renal pelvis and ureter with no filling defects (Figure 1 ).