Successful nephrectomy of isolated renal hydatid cyst associated with chronic pyelonephritis: A case report from Syria

Abstract

Hydatid disease, primarily affecting liver and lungs, poses challenges with isolated renal cysts. A 29-year-old female with intermittent right flank pain and urinary burning was diagnosed with a Bosniak category 4 hydatid cyst (HC) after positive echinococcus antibodies. Imaging confirmed the diagnosis, leading to a three-month albendazole treatment followed by right nephrectomy and partial liver resection. Histopathological analysis confirmed HC and chronic pyelonephritis. The patient had an uneventful recovery and returned to normal activities. Hydatid cysts in the kidney are rare, often requiring surgical intervention for symptomatic cases. Accurate diagnosis and timely surgical intervention are crucial for effective management.

Highlights

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Ultrasound and CT scans are crucial for diagnosing renal hydatid cysts (HCs) and guiding surgical planning.
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Albendazole is administered preoperatively to reduce cyst size and prevent dissemination, enhancing surgical outcomes.
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Post-surgical histopathology provides definitive diagnosis, revealing HCs and associated conditions like chronic pyelonephritis.
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Effective management of renal HCs requires collaboration among urologists, infectious disease specialists, and radiologists.

1 Introduction

Hydatid disease (HD), also referred to as echinococcosis, is a parasitic infection transmitted from animals (such as sheep and dogs) to humans, caused by the larval form of the tapeworm Echinococcus granulosus. This disease is commonly found in regions such as Eastern Europe, South America, the Middle East, and Australia, and it can also be observed in individuals from South Asian countries. The urogenital region ranks third in frequency for HD, following the liver and lungs, which are the primary sites affected in over 90 % of cases. While renal hydatid cysts (HCs) are the most prevalent type of urogenital hydatidosis, their occurrence as an isolated condition is quite rare. Renal HC can lead to severe complications, including compression of blood vessels, infection of the cyst, shock, sepsis, and even mortality. The diagnosis is usually confirmed using imaging studies, including ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI), alongside serological tests. Surgical resection of the cysts, along with antiparasitic drugs like albendazole, represent the optimal treatment for the disease. This report describes a case of isolated renal HC in a 29-year-old woman, whose condition improved post-nephrectomy, and discusses the pathophysiology, diagnostic approaches, prognosis, and therapeutic strategies suggested to improve understanding of these rare cases.

2 Case presentation

A 29-year-old female patient presented to the urology department with intermittent right flank pain for one year and occasional urinary burning sensation without hematuria; her overall condition was stable. The patient showed no signs of cough, fatigue, weight loss, had no previous surgeries, but had frequent sheep exposure. Despite normal laboratory tests, the echinococcus antibody test yielded a positive result. Subsequent abdominal ultrasound revealed a large mid-anterior cystic lesion in the right kidney, measuring approximately 63 mm with thick walls and no significant doppler flow [ Fig. 1 ]. Contrast-enhanced CT imaging in both transverse and coronal views revealed a cystic mass with septations on the lateral side of the right kidney, featuring a thick, regular wall that enhances with contrast. This lesion is classified as Bosniak category 4, with coronal imaging showing involvement of the collecting system and contact with the liver [ Fig. 2 ]. HC was suspected based on the clinical and radiological evaluations. The chest X-ray findings were unremarkable, with no evidence of pulmonary cysts [ Fig. 3 ]. Following a three-month regimen of albendazole 400 mg administered twice daily, the patient underwent surgical intervention. An open procedure was performed through a right subcostal Kocher incision, resulting in right nephrectomy and partial liver resection due to adhesions. The specimen, weighing 372 g and measuring 13 × 8 × 6 cm, showed a large white cyst with thin walls containing a detached membrane, affecting the renal calyces and pelvis [ Fig. 4 ]. The final diagnosis was HC of the kidney accompanied by chronic pyelonephritis. Post-operative laboratory tests showed normal results, with stable urinary output and vital signs. The urinary catheter was removed after 24 hours due to adequate urinary output (2 L). The kidney drain was taken out after 3 days, with drainage volumes of 200 ml, 100 ml, and none on consecutive days. The patient returned to normal activities without complications.