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Year : 2011  |  Volume : 54  |  Issue : 3  |  Page : 640-641
Isolated renal hydatid disease with gross hydatiduria


Department of Pathology, Dr. Shankarrao Chavan Government Medical College and SGGS Hospital, Nanded, Maharashtra, India

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Date of Web Publication20-Sep-2011
 

How to cite this article:
Mudholkar VG, Suwarnkar SV, Deshpande SA, Kadam PN. Isolated renal hydatid disease with gross hydatiduria. Indian J Pathol Microbiol 2011;54:640-1

How to cite this URL:
Mudholkar VG, Suwarnkar SV, Deshpande SA, Kadam PN. Isolated renal hydatid disease with gross hydatiduria. Indian J Pathol Microbiol [serial online] 2011 [cited 2020 Nov 30];54:640-1. Available from: https://www.ijpmonline.org/text.asp?2011/54/3/640/85129


Hydatid disease is a cyclo-zoonotic parasitic infection caused by the cestode Echinococcus granulosus, which is endemic in sheep-raising countries such as India, New Zealand, South Africa, the Middle East, and Turkey. Hydatid disease may involve any part of the body. Usually the kidneys are involved as a part of multiple organ hydatidosis. However, isolated involvement of the kidney is extremely rare comprising of about 2-3% of all the cases of hydatid disease. [1] Hydatiduria accompanies only 10-20% of the cases of renal hydatidosis. We are reporting a case of isolated renal hydatid disease presenting with gross hydatiduria.

A 50-year-old man, a farmer by occupation presented with a complaint of intermittent pain and a lump in the right lumbar region since six years. He had a history of the passage of small, white, grape-sized, balloon-like structures in the urine (hydatiduria) since one month. Also, he had a history of fever, weight loss, and decreased appetite. On physical examination, a lump was palpated in the right lumbar region, which was tender with a smooth surface and ill-defined margins. His hemoglobin was 9.8 gm% and absolute eosinophil count was 1600/ cmm. The kidney function tests and chest X-ray were normal. Other hematological and biochemical investigations were within normal limits. Microscopic examination of the urine sediment showed laminated membranes of the hydatid cyst.

An abdominal ultrasonography (USG) revealed a multilocular cyst in the right kidney. Computed tomography (CT) scan of the abdomen showed a cystic lesion in the right kidney measuring 18 × 16 × 14 cm, with multiple internal septations [Figure 1]. There were no similar lesions in the other abdominal viscera. A diagnosis of renal hydatid disease was done based on the radiological and urine examination findings. Nephrectomy was planned as a modality of treatment. The patient was given oral albendazole for three weeks preoperatively. The right nephrectomy specimen received in histopathology measured 15 × 10 × 6 cm. On the cut section, the upper pole and mid-part of the kidney was replaced by a unilocular cyst measuring 8 cm in diameter containing multiple daughter cysts [Figure 2]. The cyst was communicating with a pelvicalyceal system, which was responsible for the passage of daughter cysts in the urine (gross hydatiduria). Microscopic examination showed membranes with scolices of a hydatid cyst [Figure 3]. The adjacent kidney showed evidence of chronic pyelonephritis.
Figure 1: Computed tomographic scan showing a cystic lesion in the right kidney with multiple internal septations

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Figure 2: Kidney showing hydatid cyst with multiple daughter cysts with viable parenchyma at the lower pole

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Figure 3: Hydatid membrane with scolices (H and E, ×400)

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   Discussion Top


The pathogenesis of primary hydatid disease of the kidney is postulated by the passage of hydatid embryo through the portal system into the liver and retroperitoneal lymphatics. [2] The hydatid cyst of the kidney, with all the three layers, that is, pericyst, ectocyst, and endocyst is considered to be closed. When the cyst wall ruptures into the collecting system it is called as an open or communicating cyst, which is responsible for the passage of daughter cysts in the urine (hydatiduria), pathognomonic of renal hydatidosis. [3] Gross passage of daughter cysts is rather uncommon, as in our case, and has a tremendous diagnostic utility. A common urology presentation of renal hydatid disease is of chronic dull flank pain or low back discomfort; it rarely presents with hydatiduria, ureteropelvic obstruction, and chronic renal failure. [4] Shailaja Shukla et al. has described a case of multiple disseminated abdominal hydatidosis involving the liver, spleen, kidney, and peritoneal cavity, presenting with gross hydatiduria. [5] Treatment options for renal hydatid disease include surgical and medical therapy. In our case, total nephrectomy was performed and the postoperative period of the patient was uneventful.

 
   References Top

1.Mongha R, Narayan S, Kundu AK. Primary hydatid cyst of kidney and ureter with gross hydatiduria: A case report and evaluation of radiological features. Indian J Urol 2008;24:116-7.  Back to cited text no. 1
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2.Pedrosa I, Saiz A, Arrazola L, Ferriiros J, Pedrosa CS. Hydatid disease: Radiologic and pathologic features and complications. Radiographics 2000;20:795-817.  Back to cited text no. 2
    
3.Unsal A, Cimentepe E, Dilmen G, Yenidunya S, Saglam R. An unusual case of renal colic: Hydatiduria. Int J Urol 2001;8:319-21.  Back to cited text no. 3
    
4.Ya Yciogluo, Ulusan S, Gul U, Guvel S. Isolated renal hydatid disease causing ureteropelvic junction obstruction of kidney parenchyma. Urology 2006;67:15-7.  Back to cited text no. 4
    
5.Shukla S, Singh SK, Pujani M. Multiple disseminated abdominal hydatidosis presenting with gross hydatiduria: A rare case report. Indian J Pathol Microbiol 2009;52:13-4.  Back to cited text no. 5
    

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Correspondence Address:
Vishal G Mudholkar
"Aadarsh Sadan" ND-42, D-1, 10/2, Sambhaji Chowk, CIDCO, New Nanded - 431 603, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.85129

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    Figures

  [Figure 1], [Figure 2], [Figure 3]

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