Case Report: Total Nephrectomy for Renal Hydatidosis

Abstract

Cystic echinococcosis, known as hydatidosis, is a parasitic zoonosis caused by the larvae of Echinococcus granulosus. Renal hydatidosis is a very rare condition, representing 1% to 2% of cases. We present an 18-year-old patient who, after suffering a trauma, experienced severe lower back pain and persistent gross hematuria disproportionate to the trauma. Ultrasonography and tomography revealed cystic images compatible with right renal hydatidosis and hemoperitoneum. In addition, rapid clinical deterioration was observed with decreased hematocrit, leading to lumpectomy with abundant cysts inside and outside the right kidney, without viable parenchyma. Therefore, a total nephrectomy was performed. The patient was discharged with albendazole treatment. Pathological anatomic analysis confirmed the diagnosis of hydatidosis. Surgery remains the best therapeutic option. The use of ultrasonography improves the early detection of zoonosis, especially in pediatric patients, and favors the use of more conservative therapeutic techniques.

Figure 1.

Diagnostic aid images (A) ultrasonography and (B) computerized axial tomography. (A) Echogenic image of irregular borders in the right renal sinus, fluid in the peritoneal cavity, and loss of corticomedullary differentiation. (B) Contrast tomography showing several liquid–density images in the right renal parenchyma separated by higher density septa, with loss of morphology of the right kidney and renal pelvis without contrast enhancement. This figure appears in color at www.ajtmh.org.

Figure 2.

Surgical specimen, multiple hydatids, and hydatid membrane. (A) Right kidney, 11.5 × 8 × 3.5. The section shows the parenchyma with multiple translucent white cysts in the hilar and medullary areas. (B) Cystic capsule approximately 6.5 cm in diameter. This figure appears in color at www.ajtmh.org.

Figure 3.

Anatomic histopathology. (A) Degenerated laminated membrane of a hydatid cyst adhered to the host fibrinoid wall. (B) Adjacent renal parenchyma presents a chronic inflammatory reaction with foci of ischemic coagulative necrosis that compromises tubules, interstitium, and glomeruli. Hematoxylin–eosin stain ×10 magnification. This figure appears in color at www.ajtmh.org.