Ultrasonographic Features of the Kidney in Patients With Frasier Syndrome and Stage 5 Chronic Kidney Disease: A Case Report and Literature Review.

BACKGROUND

Frasier syndrome (FS) is a rare WT1-related disorder characterized by progressive nephropathy and diffuse renal parenchymal damage on imaging. Ultrasonographic findings of end-stage kidney disease in FS have rarely been documented.

METHODS

We present the case of a 12-year-old boy who was diagnosed with FS, harbored a heterozygous c.1447+5G>A mutation in his WT1 gene, and developed CKD Stage 5. Renal ultrasonography and non-contrast CT were performed. A systematic literature review was conducted to contextualize the imaging findings.

RESULTS

Non-contrast CT revealed multiple areas of abnormal density in both kidneys, which raised suspicion of Wilms tumor. Ultrasonography demonstrated multiple avascular, non-encapsulated nodular hyperechoic areas on a background of diffusely abnormal parenchyma and ruled out malignant tumors. The literature review confirmed that similar findings have rarely been reported in FS patients with CKD Stage 5.

CONCLUSION

These findings describe a distinctive end-stage renal ultrasound pattern in FS. Recognition of this pattern may help clinicians avoid unnecessary invasive procedures when renal malignancy is suspected in patients with advanced CKD.