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Case Reports
. 2021 Sep 29;15(1):487.
doi: 10.1186/s13256-021-02992-2.

Challenges in treatment of renal echinococcosis with gross hydatiduria and unsalvageable kidney: a case report

Sameera Shuaibi  1 , Abdelrahman AlAshqar  2 , Munirah Alabdulhadi  3 , Wasl Al-Adsani  4   5
Affiliations
Case Reports

Challenges in treatment of renal echinococcosis with gross hydatiduria and unsalvageable kidney: a case report

Sameera Shuaibi et al. J Med Case Rep. .

Abstract

Introduction: Renal echinococcosis is of rare occurrence, and although often asymptomatic, it can present with various mild to drastic presentations, of which hydatiduria is pathognomonic. Diagnosis can be preliminarily established by imaging, and treatment is primarily surgical. We present a patient with renal echinococcosis treated successfully with exclusive antiparasitic pharmacotherapy after refusing surgery despite extensive renal involvement. We hope through this report to help establish future solid guidelines regarding this uncommon therapeutic approach.

Case presentation: This is a case of a 49-year-old Syrian shepherd presenting with flank pain and passage of grape-skin-like structures in urine. A diagnosis of renal echinococcosis with hydatiduria and significant parenchymal destruction was established based on exposure history, positive serology, imaging findings, and renal scintigraphy. After proper counseling, the patient refused nephrectomy and was therefore started on dual pharmacotherapy (albendazole and praziquantel) and is having an uneventful follow-up and a satisfactory response to treatment.

Conclusion: This case embodies the daily challenges physicians navigate as they uphold the ethical principles of their practice and support their patients' autonomy while delivering the best standards of care and consulting the scientific evidence. Although surgery is the cornerstone of renal echinococcosis treatment, treating physicians should be prepared to tackle situations where surgery cannot be done and offer the best next available option for patients who refuse surgery. As data on exclusive pharmacotherapy are limited, future research should thoroughly investigate the efficacy of this uncommon approach and outline reliable recommendations, facilitating future clinical decision-making in this avenue.

Keywords: Albendazole; Case report; Hydatid cyst; Hydatiduria; Renal echinococcosis.

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Conflict of interest statement

The authors declare that they have no competing interests

Figures

Fig. 1
Fig. 1
Gross hydatiduria as evidenced by passing cream-colored grape-skin-like structures in urine representative of daughter cysts
Fig. 2
Fig. 2
Contrast-enhanced CT showing three hydatid cysts occupying most of the parenchyma of the right kidney (red arrows) with evidence of cyst communication with the pelvicalyceal system (yellow arrow)
Fig. 3
Fig. 3
Schematic presentation of the pathophysiology, pathologic anatomy, and possible manifestations of renal echinococcosis. The figure was created by AA, an author of this manuscript
See this image and copyright information in PMC

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