Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
Users Online: 588
Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions | Subscribe | Contacts | Login 

 Table of Contents  
Year : 2012  |  Volume : 2  |  Issue : 1  |  Page : 58-60  

Left renal hydatid cyst presenting as hematuria and macroscopic hydatiduria since last ten years

J.N. Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India

Date of Acceptance16-Jan-2012
Date of Web Publication16-Jun-2012

Correspondence Address:
Pankaj Gharde
J.N. Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra - 442 004
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2229-5070.97242

Rights and Permissions

Renal hydatidosis represents only 2-3% of hydatid disease. It is endemic in parts of eastern Europe, middle East, south America, Australia, New Zealand, Alaska, and Canada. Cystic rupture into the collecting system causes hydaturia; isolated renal involvement is even rarer. Here we report a case of left renal hydatid cyst in a 40 year old man presenting as hematuria and macroscopic hydaturia since last ten years. The patient underwent exploratory laparotomy and recovered.

Keywords: CT scan, hydatiduria, renal lump

How to cite this article:
Gharde P, Wagh D D, Patil A. Left renal hydatid cyst presenting as hematuria and macroscopic hydatiduria since last ten years. Trop Parasitol 2012;2:58-60

How to cite this URL:
Gharde P, Wagh D D, Patil A. Left renal hydatid cyst presenting as hematuria and macroscopic hydatiduria since last ten years. Trop Parasitol [serial online] 2012 [cited 2022 Nov 26];2:58-60. Available from: https://www.tropicalparasitology.org/text.asp?2012/2/1/58/97242

   Introduction Top

Renal hydatidosis represents only 2-3% of hydatid disease. The clinical features of renal hydatid are mass in the flank, renal colic, persistent fever, hematuria, dysuria, pyuria, renal stones, or hypertension. Cystic rupture into the collecting system causes hydatiduria, seen in only 10-20% of renal hydatid and is usually microscopic. Gross passage of the daughter cyst is rather uncommon. [1] The diagnosis of the primary hydatid cyst of the kidney is usually radiological, most patients have negative immunological tests. It is endemic in parts of Eastern Europe, Middle East, South America, Australia, New Zealand, Alaska, and Canada. [2],[3] Hydatid disease is caused by the cestode Echinococcus granulosus. Isolated renal involvement is even rarer. A late diagnosis due to uncommon clinical manifestations is considered to be the main reason for the loss of the organ. [1],[2]

We present a case of a 40-year-old male, with isolated renal hydatid with hydatiduria, a very rare presentation, and its management by transperitoneal enucleation of the hydatid cyst. Gross hydatiduria is a very rare presentation of hydatidosis as seen in our case.

   Case Presentation Top

A 40-year-old male presented with colicky abdominal pain for 10 years and intermittent passage of small, white grape-like structures in the urine [Figure 1] along with intermittent hematuria; whenever he passed the daughter cyst in urine he was relieved. He was taking analgesics on feeling of pain. He came for admission as the pain had subsided but there was dysuria and nausea. On systemic examination, the abdomen was normal. Hemogram was normal and liver function tests were within normal limit, blood urea was 55 mg/dl and serum creatinine was 1.7 mg/dl. The chest X-ray P-A view was normal.
Figure 1: CT scan showing hydatid cysts present in upper pole of Kidney

Click here to view

Ultrasonography revealed a multiseptate cyst in the left kidney. The left kidney was compressed by cysts with splitting of the pelvicalyceal system. The right kidney was normal in size and echotexture, liver was normal. The computed tomography (CT) scan revealed a cystic lesion in the upper pole of the left kidney [Figure 2] and the upper ureter. The excretion of contrast was normal from both the kidneys. The patient was started with albendazole. After 1 week, the patient underwent exploratory laparotomy, descending colon was mobilized, and left kidney [Figure 3] was exposed, and a hydatid cyst was located [Figure 4]. The hydatid cyst was laid open after instillation of the cetrimide solution and 176 small and large daughter cysts [Figure 5] were taken out of the cavity, the cavity was capitulated as we do after excision of lung hydatid. The patient was discharged after 8 days and was advised albendazole 400 mg BD for 4 weeks.
Figure 2: Hydatid cyst excreted in urine

Click here to view
Figure 3: Normal kidney and a hydatid cyst wall at upper pole of kidney

Click here to view
Figure 4: Incision made over a hydatid cyst showing daughter cysts

Click here to view
Figure 5: Photograph of some of the hydatid cyst

Click here to view

   Discussion Top

Hydatid disease, also known as echinococcosis, is caused by infection with the larva of the tapeworm of the genus Echinococcus. [3] The two most common organs involved are the liver (65%) and the lungs (25%). Other less common sites are bones 5%, kidney 3%, spleen 2%, heart 1%, pancreas 1%, and central nervous system 1%. [2],[3] Renal hydatid cysts usually remain asymptomatic for years. However, the patient may present with renal pain, hematuria, pyuria, and intermittent fever. Rupture of the cyst into the renal collecting system causing hydatiduria is pathognomonic and is seen in only 10-20% of the renal hydatidosis. It is usually microscopic. Macroscopic hydatiduria is very rare. [2]

Serology and imaging modalities establish the diagnosis in most of the cases. [4] Serology consists of immuno-electrophoresis, immuno-hemagglutination test, and complement fixation test. The Casoni test is unreliable and outdated. A combination of investigations yields a diagnosis in only 50% of cases. [3] The enzyme-linked immunosorbent assay is the most widely used assay. The confirmatory test is arc 5 immunoelectrophoresis. It detects antibodies against immune-dominant and specific antigen, antigen 5 of the cestode. A polymerase chain reaction (PCR) using a recombinant DNA antigen is useful in defining the particular species of Echinococcus. Abdominal ultrasonography and CT scan are wonderful in establishing the diagnosis of hydatid disease. [4] Magnetic resonance imaging (MRI) has no real advantage over CT scan. Accuracy and sensitivity of CT scan is better as compared to ultrasonography (USG). [2] USG helps in the diagnosis of hydatid cysts when the daughter cysts and hydatid sand are demonstrated. On changing the patient's posture under real time, there is shifting of hydatid sand, which may give rise to the "falling snowflake pattern". [2],[3] Intravenous Urogram must be done to rule out, a communication with renal ductal system and functioning of both the kidneys. [3]

In general, surgery is the treatment of choice in renal hydatid cyst. Kidney-sparing surgery is done in 75% cases. [4] Nephrectomy is a last resort in 25% of cases. Utmost care should be taken during the surgery to prevent spillage which may result in disseminated hydatidosis. Pre- and postoperative one-month courses of albendazole should be considered in order to sterilize the cyst, decrease the chance of anaphylaxis, and reduce the tension in the cyst wall (thus reducing the risk of spillage during surgery) and to reduce the recurrence rate postoperatively. During kidney-sparing surgery, scolicidal solutions such as hypertonic, cetrimide, povidone iodine should be used before opening the cavities to kill the daughter cysts and therefore prevent further spread or anaphylactic reaction. [2],[5] Surgical management consists of various options. Total excision consists of either wedge resection or partial nephrectomy and partial excision includes partial pericystectomy followed by capitonnage. [3] It is recommended to start the patient on a course of oral albendazole after surgery. [4] The treatment is mainly surgical and with appropriate diagnosis and treatment, prognosis is good. [5]

We believe from our experience with transperitoneal approach that transperitoneal approach gives a better working space, which helps us to remain outside Gerota's fascia and prevent subsequent cyst rupture. But cases have been reported where renal hydatid cysts had been removed retroperitoneally.

   References Top

1.Shukla S, Singh SK, Pujani M. Multiple disseminated abdominal hydatidosis presenting with gross hydatiduria: A rare case report. Indian J Pathol Microbiol 2011;52:213-4.  Back to cited text no. 1
2.Mongha R, Narayan S, Kundu AK. Primary hydatid cyst of kidney and ureter with gross hydatiduria: A case report and evaluation of radiological features. Indian J Urol 2008;24:116-7.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.Shukla A, Garge S, Verma P. A case of large renal hydatid cyst. Saudi J Kidney Dis Transpl 2011;22:538-40.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.Shah KJ, Ganpule AP, Desai MR. Isolated renal hydatid cyst managed by laparoscopic transperitoneal nephrectomy. Indian J Urol 2009;25:531-3.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.Prabhudessai SC, Patankar RV, Bradoo A. Laparoscopic treatment of renal hydatid cyst. J Minim Access Surg 2009;5:20-1.  Back to cited text no. 5


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]

This article has been cited by
1 A simple score for predicting urinary fistula in patients with renal hydatid cysts
Kays Chaker, Yassine Nouira, Yassine Ouanes, Mokhtar Bibi
Libyan Journal of Medicine. 2022; 17(1)
[Pubmed] | [DOI]
2 Paediatric renal hydatid cyst
G Polat,B Pirimoglu,R Sade,M Kantarci
QJM: An International Journal of Medicine. 2018;
[Pubmed] | [DOI]
3 An Unusual Case of Pain in Left Flank: Renal Hydatid Cyst
Govind Yadav
MOJ Surgery. 2017; 4(1)
[Pubmed] | [DOI]
4 Membranous material in the urine: A diagnosis of cystic echinococcosis at first glance
Claudio Musetti,Gabriele Guglielmetti,Marco Quaglia,Cristina Izzo,Vincenzo Cantaluppi
Nephrology. 2016; 21(6): 529
[Pubmed] | [DOI]
5 Presence of an Isolated Hydatid Cyst in the Left Kidney: Report of a Case of This Rare Condition Managed Surgically
Daniel Paramythiotis,Petros Bangeas,Konstantinia Kofina,Vassileios Papadopoulos,Antonios Michalopoulos
Case Reports in Urology. 2016; 2016: 1
[Pubmed] | [DOI]
Pushpa Ranjan,Rajeev Ranjan
Journal of Evolution of Medical and Dental Sciences. 2015; 4(51): 8950
[Pubmed] | [DOI]
Pulak Kumar Datta,Asim Kumar Das
Journal of Evolution of Medical and Dental Sciences. 2015; 4(01): 147
[Pubmed] | [DOI]
8 A rare case of primary renal hydatid cyst presenting with hydatiduria
Arghya Bandyopadhyay,Subhadip Khatua,Sanjushree Das,Kousik Bose,Karabi Konar
Journal of Parasitic Diseases. 2013;
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
   Case Presentation
    Article Figures

 Article Access Statistics
    PDF Downloaded128    
    Comments [Add]    
    Cited by others 8    

Recommend this journal