Changes

== Clinical Summary == During the course of a routine physical examination two months prior to admission, this 57This 17-year-old white male was noted had end-stage renal disease requiring hemodialysis for 10 years. For the previous four years he had hypertension which slowly increased to have about 180/120 mm Hg. Laboratory findings included a lesion in the upper lobe of the right lung. Initially, he was treated for two weeks with ampicillingreatly elevated BUN and creatinine. He was then admitted to an outside hospital for further study. All studies including sputum studies for tubercle bacilli, bronchial washings, bilateral nephrectomy and bronchoscopy were negative and he was discharged. Review of systems revealed in satisfactory condition on the presence of mild dyspnea on exertion, accompanied by a slightly productive cough10th postoperative day. Of interest He was the fact that the patient had been PPD positive for the past 4 to 5 years, but this had never been evaluated. On this hospital admission, physical and laboratory examinations were negative. Radiographic examination of the chest revealed a 2 x 2-cm density be contacted in the right lower lung field. Several small cavities were identified in this area on CT scanfuture for transplantation.

== Autopsy Findings == The patient underwent left (97 grams) and right (88 grams) kidneys were of similar appearance. Cortices were pale, diffusely granular with a thoracotomyfew 1-2 mm cysts. On being sectioned, at which time a portion of the upper lobe cortex of the right lung each kidney was removedthin (4-5 mm) and pale. Examination of the cut surface revealed small white nodules measuring up to 0Renal medullae were pale yellow-tan in color and there was abundant peripelvic fat.2 cm in diameterThe ureters, pelvis, calyces and hilar vessels showed no abnormalities.