English

Abstract

We report a case of primary echinococcosis of left kidney presenting with gross hydatiduria. Important diagnostic features are also discussed. INTRODUCTION: Kidney involvement in echinococcosis is extremely rare, constituting only 2-3% of all cases.[1,2,3,4] Primary involvement of the kidney without the involvement of the liver and lungs is even rarer. Hydatiduria accompanies only 10-20% of all cases of renal hydatidosis and is usually microscopic.[2] We present a rare case of primary left renal hydatid with gross hydatiduria. The diagnosis of primary hydatid cyst of the kidney, in the absence of hydaturia, is usually radiological as most patients have negative immunological tests. We also present the salient radiological features of primary hydatid cyst of kidney. CASE REPORT: A 25-year-old male presented with history of intermittent passage of small, white, balloon-like, grape-sized structures in the urine for the last one month. He also had intermittent hematuria for 15 days. Abdominal examination did not reveal any palpable lump. Rest of the systemic examination was normal. His routine blood investigations were normal with no eosinophilia and normal renal function tests. X-ray chest P-A view was normal. The USG abdomen revealed multiseptate cyst in the left kidney; liver was normal. The CT scan revealed a cystic lesion in the left kidney (Figure 1). Left Kidney was not ex-creating Patient was planned for surgery by flank extraperitoneal approach. Left nephroureterectomy was done. Patient received four weeks of preoperative albendazole which was continued for four weeks postoperatively. The resected specimen showed kidney with bag of cysts with multiple daughter cysts (Figure 2). The histopathological examination was consistent with left renal hydatid disease and multiple daughter cysts. DISCUSSION: Echinococcosis is a worldwide zoonosis produced by the larval stage of the Echinococcus tapeworm. In this case, hydatid disease was caused by one of the main types, E granulosus. The adult worm lives in the proximal small bowel of the definitive host, attached by hooklets to the mucosa. Eggs are released into the host’s intestine and excreted in the feces. Humans may become intermediate hosts through contact with a definitive host (Usually a domesticated dog) or ingestion of contaminated water or vegetables. The ovum loses its protective layer as it is digested in the duodenum. Once the parasitic embryo passes through the intestinal wall to reach the portal venous system or lymphatic system, the liver acts as the first line of defense and is therefore the most frequently involved organ. In humans, hydatid disease involves the liver in approximately 75% of cases and the lung in 15%.[2,4] Secondary involvement due to hematogenous dissemination may be seen in almost any anatomic location. Kidney involvement in echinococcosis is extremely rare (2%– 3% of cases), even in areas where hydatid disease is endemic. Renal hydatid cysts usually remain asymptomatic for many years.[3] DOI: 10.14260/jemds/2015/24