MRCP2-4122

MRCP2-4122

A 53-year-old man with diabetes presents with weight loss, fevers and dull, persistent left loin pain. He has been treated for relapsing urinary tract infections with oral antibiotics.

On examination, his temperature is 37.9 °C, blood pressure is 130/80 mmHg and chest and abdominal examination is unremarkable.

Investigations:
Haemoglobin (Hb) 143 g/l 135 – 175 g/l
White cell count (WCC) 18 × 109/l 4.0 – 11.0 × 109/l
Platelets (PLT) 510 × 109/l 150 – 400 × 109/l
Sodium (Na+) 145 mmol/l 135 – 145 mmol/l
Potassium (K+) 4.2 mmol/l 3.5 – 5.0 mmol/l
Urea 12 mmol/l 2.5 – 6.5 mmol/l
Creatinine (Cr) 120 μmol/l 50 – 120 µmol/l
Erythrocyte sedimentation rate (ESR) 67 mm/h 1 – 20 mm/h
Computerised tomography scan shows a heterogeneous non-enhancing mass on the left kidney, which is hydronephrotic. The right kidney is normal.
Renal biopsy shows lipid-laden macrophages with lymphocytes and polymorphonuclear leukocytes.

What is the definitive treatment in this patient?