The patient is taken to HDU for supportive management.  The patient is commenced on treatment for hyperkaleamia.  His fluid balance is carefully monitored.  He is catherised, given analgesia for his abdominal pain.  He requires inotropic support.  An uss abdomen is performed.  This shows severe right sided hydronephrosis, and moderate left sided hydronephrosis.  It also shows extensive retroperitoneal lymphadenopathy which is causing obstruction of both ureters.  USS also identifies moderate splenomegaly.

Bloodfilm is reviewed by the haematology registrar, which shows a leucoerythroblastic picture, anisocytosis, and thrombocytopenia.

Some further test results included:

uric acid 1562  (238 – 506 µmol/)

HIV is sent

Urine dipstick negative.

What are your next steps in this patients management?