Bilateral Nephroblastoma in a Toddler: Hypertension as a Critical Diagnostic Clue

Bilateral nephroblastoma, also known as Wilms tumor, represents a rare yet critical pediatric renal malignancy. Hypertensive emergencies with seizures are exceptional. We report the case of an 18-month-old girl who presented with status epilepticus secondary to malignant hypertension (180/120 mmHg) associated with a two-week history of abdominal distension. Clinical examination revealed bilateral lumbar masses, and computed tomography confirmed the presence of bilateral renal tumors, the largest measuring 102 × 80 × 100 mm. Neoadjuvant chemotherapy resulted in a partial response, with tumor size reduced to 69 × 60 × 63 mm, pending nephron-sparing surgery. Rapid diagnosis is crucial, as seizures presenting as the initial manifestation are rare and may delay recognition of the underlying abdominal pathology. Early imaging in cases of pediatric hypertension can prevent severe complications and improve outcomes, allowing renal preservation with survival rates exceeding 85%. Wilms tumor should be suspected in hypertensive toddlers presenting with abdominal signs, and prompt ultrasound evaluation is essential to avoid diagnostic delay and associated complications.