Wilms tumor (nephroblastoma) is the most common renal malignancy in children, with bilateral involvement occurring in approximately 5% of cases. We present the case of a two-year-old male who was evaluated for fever and incidentally found to have a palpable abdominal mass. Imaging revealed bilateral renal masses, with a large heterogeneously enhancing lesion in the left kidney and smaller lesions in the right. Trucut biopsy confirmed a diagnosis of nephroblastoma with predominant blastemal and mesenchymal components, without anaplastic features. The patient was managed according to the SIOP protocol, receiving six cycles of neoadjuvant chemotherapy (AV regimen), followed by a left nephroureterectomy with lymph node sampling. Histopathology staged the tumor as Stage I, intermediate risk. The patient continues to be monitored with regular imaging, and conservative management for the right kidney is being considered given the absence of significant residual disease. This case highlights the importance of early diagnosis, multidisciplinary management, and the careful balancing act between tumor control and renal preservation in bilateral Wilms tumor.

Aakansha is an International medical graduate. Completed her MBBS from SDM University and was a student under Dr.Zulpi. She is passionate about Pediatrics and her special interests lean towards Nephrology and Genetics.