Renal scars masquerading as complex masses in a patient with vesicoureteral reflux nephropathy

Vesicoureteral reflux can lead to chronic pyelonephritis, renal scarring, a nd renal failure. We present a case of renal scarring masquerading as bilat eral, complex renal masses. A 35-year old woman who was diagnosed with vesi coureteral reflux as a child presented for evaluation of recently developed hypertension and an abnormal renal ultrasound. Her serum creatinine level was 2.5 mg/dL and she had subnephrotic-range proteinuria. A renal sonogram showed small, echogenic kidneys and bilateral complex renal masses of 3.8 ( right) and 4.4 (left) cm in greatest dimensions. CT scan of the kidneys rev ealed slightly contrast-enhancing masses with irregular walls. Renal angiog ram showed decreased blood supply to the areas coinciding with the masses c onsistent with renal scarring. There was no increased vascularity. This cas e demonstrates that renal scarring may masquerade as renal masses. A step-w ise, comprehensive approach is necessary to rule out potentially malignant lesions in these patients.