Isolated renal echinococcosis with hydatiduria in a girl.

Abstract

Hydatid disease is a common occurrence in the Indi-an subcontinent, however involvement of kidneys constitutes only about 2-4% of cases.[1] Isolated renal involvement without involvement of liver or lung is even more rare. Associated hydatiduria is seen in only 10-20% of all cases of renal hydatidosis and involvement of ureter is rarely reported.[2] Though, due to slow evolvement and asymptomatic nature, hydatid disease is rarely seen in children, one such isolated hydatid disease of right kidney and ipsilateral ureter is reported here in an adolescent girl who presented with recurrent renal colic and gross hydatiduria. A fifteen year old girl referred to our institute for complaints of colicky pain in right lumbar region and dysuria with passage of small pale ruptured-grape like structures in urine for the last 6 months. Her general physical examinations and routine investiga-tions were in normal limits. Ultrasonography of ab-domen was suggestive of multiloculated cystic le-sion, with typical spoke-wheel appearance, in the mid pole of right kidney and ELISA test was positive for echinococcus antibodies. CT scan obtained which revealed 11.5 cm X 11.0 cm multiseptated cystic lesion in mid and lower pole of right kidney and upper ureter with typical “cyst within the cyst” appearance (Fig. 1), without any contrast excretion from right kidney. With four weeks of albendazole therapy, surgical exploration done by flank extraperitoneal approach and right nephroureterectomy done as almost entire kidney was converted into a bag of cysts with multiple cysts filled up in the upper ureter as well (Fig. 2). Postop-eratively, patient was put on albendazole (10 mg/kg daily) for eight weeks. Histopathological examination was consistent with hydatid disease. Follow-up ultra-sound abdomen at 6 months showed no recurrence.