Acute pyelonephritis mimicking acute abdomen: An atypical presentation of unilateral dysplasia of the kidney in an adult

Abstract

Multicystic dysplastic kidney is a nongenetic, congenital, cystic renal disease in which the renal cortex is replaced by numerous cysts of multiple sizes. The most common clinical presentation of unilateral renal dysplasia is abdominal lump in a new born infant who is otherwise healthy. Unilateral renal dysplasia is compatible with life. In adults, it is either diagnosed incidentally, can be an autopsy finding, or very rarely is symptomatic. Presented here is an unusual clinical presentation of unilateral renal dysplasia in a 30-year-old woman who presented with acute severe right lumbar and iliac fossa pain. Ultrasound and computerized tomography scans of the abdomen revealed absent right kidney with compensatory hypertrophy of the left kidney. As symptoms did not settle with standard conservative line of treatment, cystoscopy with retrograde pyelography was performed for evaluation of microscopic hematuria. A diagnosis of dysplastic kidney was made; exploratory laparotomy with right nephroureterectomy was performed. Patient had a smooth postoperative course. Histopathology confirmed renal dysplasia with pyelonephritis.