Case Report: Total Nephrectomy for Renal Hydatidosis

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.

Renocolic fistula following a partial nephrectomy: a case study

Background Uro-digestive fistulae are uncommon. They frequently manifest themselves with mild symptoms but can, in some cases, be life-threatening leading to septic shock and death. The diagnosis is facilitated by radiological explorations and their management remains mainly surgical. Case presentation We report the case of a diabetic 62-year-old patient who developed a renocolic fistula revealed by a digestive symptomatology, following a partial nephrectomy that was surgically treated with positive overall outcome. Conclusion The development of a fistula between the colon and the kidney is very rare. Although the outcome was positive at the price of total nephrectomy and partial colectomy, the diagnosis and management of the fistula were challenging. Urologists should keep in mind the possibility of a fistula developing in the aftermath of a partial nephrectomy.

Quantitative morphometrics reveals glomerular changes in patients with infrequent segmentally sclerosed glomeruli

AimsDetection of one segmentally sclerosed glomerulus (SSG) identifies patients with focal segmental glomerulosclerosis (FSGS) but rare SSGs may be missed in kidney biopsies. It is unknown whether alterations of unaffected glomeruli in patients with infrequent SSG can be detected by quantitative morphometrics.MethodsWe determined SSG frequency and obtained quantitative morphometrics in glomeruli without a pathologic phenotype in large kidney sections of non-involved kidney tissue from 137 patients undergoing total nephrectomy. We used multivariate modelling to identify morphometrics independently associated with increasing frequency of SSG and Receiver Operator Curve (ROC) analysis to determine the ability of quantitative morphometrics to identify patients with FSGS. We used the geometric distribution to estimate the sensitivity and specificity of a needle biopsy to identify patients with FSGS.ResultsIn seventy-one patients (51.8%), at least one SSG was observed, and of those, 39 (54.9%) had an SSG lesion in less than 2% of all glomeruli (mean of 249 glomeruli per specimen). Increasing percent of SSG was independently associated with decreasing podocyte density and increasing mesangial index in multivariate modelling. For infrequent SSG lesions (<1% of glomeruli), kidney biopsy could miss FSGS diagnosis more than 74% of the time, and podocyte density had an area under the curve (AUC) of 0.77, and mesangial index, an AUC of 0.79 to identify patients with FSGS.ConclusionsMore than half of patients had FSGS, although 30% had infrequent SSG. Quantitative morphometrics in glomeruli without pathology, such as podocyte density and mesangial index, identified patients with infrequent SSG and may serve as clinical markers to identify patients with FSGS.

Single Renal Metastasis From Cervical Cancer

63-year-old patient, followed for cervical cancer classified 2b; declared cured after a treatment with chemo-radiotherapy and brachytherapy and who presents after 10 months of his last treatment session a fortuitous discovery of a right renal mass The patient subsequently benefited from a right enlarged total nephrectomy whose anatomo study pathology showed the appearance of a secondary epidermoid carcinoma of cervical neo. In our case, there is a single renal metastasis of cervical cancer with no local development and after 10 months from the end of treatment.