Giant hydronephrosis due to ureteropelvic junction obstruction: A rare case report, and a review of the literature

Abstract

The hydronephrotic kidney, resulting from a ureteropelvic junction obstruction (UPJO), presents commonly as a clinical condition, with the presence of usually no more than 1-2 liters in the collecting system, but a very small number of cases of giant hydronephroses (GHs) has been reported in adults. A GH is defined as the adult renal pelvis containing >1 liter of urine, or at least 1.5% of the body weight. In the majority of cases, the range of the hydronephrotic kidney remains restricted to the renal area. However, the patient described in the present case report had a range for the hydronephrotic kidney which occupied almost the entire abdominal cavity (~24 l), and cases such as these are rarely presented; therefore the aim of the present case study was to document a clear case of GH resulting from UPJO, also accompanied by a review of the current literature.

Keywords: giant hydronephrosis; ureteropelvic junction obstruction (UPJO).

Figure 1.

(A) Preoperative photograph of the patient showing the grossly distended abdomen caused by GH of the right kidney. (B) Postoperative photograph of the patient following nephrectomy of the affected side.

Figure 2.

(A) CT scan of a GH of the right kidney (30.6×19.9 cm; transverse section). (B) CT scan of a GH of the right kidney (41.1×30.5 cm; coronal section). (C) CT scan of a GH of the right kidney (40.0×18.6 cm; vertical plane). (D) CT scan of a GH of the right kidney following drainage by urethral catheterization. CT, computerised tomography; GH, giant hydronephrosis.

Figure 3.

(A) Close-up photograph of the cystic dilatation kidney following surgery. (B) Gross photograph of the cystic dilatation kidney following surgery.

Figure 4.

(A) Pathological section from the right kidney (H&E staining, magnification, ×400). (B) Pathological section from the right kidney (H&E staining, magnification, ×200). H&E, hematoxylin and eosin.