| Abstract|| |
In this retrospective study, we present our experience on the diagnosis and management of isolated Hydatid disease of the kidneys. Between January 1999 and January 2003, eight patients were diagnosed to have Hydatid disease of the kidney and constituted the subjects of this study. Their age ranged between 20 and 63 years age (mean 40); there were five males and three females. Loin pain was the commonest mode of presentation in these patients. Investigations performed included urine analysis, serological tests, eosinophil count and relevant radiological studies. Urine analysis showed hydatiduria in one patient, the Casoni's test was positive in two, Ghedini skin test was positive in three and eosinophilia was noted in two other patients. All patients were treated surgically using loin supracostal extra-peritoneal approach. Total nephrectomy was performed in five patients, partial nephrectomy in one while excision of the cyst was performed in two patients. Our report suggests that a combination of various investigative modalities with a high index of suspicion is necessary in establishing the correct diagnosis. Surgery remains the main option of treatment for renal hydatid disease.
Keywords: Hydatid disease, Kidney, Casoni′s test, Nephrectomy
|How to cite this article:|
Abu-Qamar AA, Aljader KM, Habboub H. Isolated Renal Hydatid Disease: Experience at the Queen Rania Urology Center, The King Hussein Medical Center. Saudi J Kidney Dis Transpl 2004;15:149-54
|How to cite this URL:|
Abu-Qamar AA, Aljader KM, Habboub H. Isolated Renal Hydatid Disease: Experience at the Queen Rania Urology Center, The King Hussein Medical Center. Saudi J Kidney Dis Transpl [serial online] 2004 [cited 2020 Jun 2];15:149-54. Available from: http://www.sjkdt.org/text.asp?2004/15/2/149/32897
| Introduction|| |
Hydatid disease is a cyclo-zoonotic parasitic infection caused by the cestode Echinococcus granulosus and it is endemic in sheep-raising countries such as India, parts of Africa, New Zealand, South America, Australia, South Europe, the Middle East and Turkey. , Humans are the incidental intermediate hosts of the disease. , Hydatid disease of the kidney is rare and is responsible for only 2 to 3% of all hydatid disease. ,
The controversy concerning the optimal method of treatment of renal hydatid disease (scolicidal agent injection, marsupialization, percutaneous drainage, simple cystectomy and total nephrectomy) continues. However, surgery continues to be the main treatment modality. Excision of the cyst with conservation of the renal parenchyma is the most appropriate treatment, but is not always feasible. , In this study, we report on our experience in the management of isolated hydatid disease of the kidney at The Queen Rania Urology Center, The King Hussein Medical Center, Amman, Jordan.
| Patients and Methods|| |
Between January 1999 and January 2003 we treated eight patients with isolated renal hydatid disease of whom five were males and three, females; their ages ranged from 20 to 63 years. None of these patients had involvement of any other organs. The clinical signs and symptoms, results of laboratory tests and treatment offered to these patients are listed in [Table - 1]. The investigations that were performed in all the patients included eosinophil count, Casoni's skin test, complement fixation test of Ghedini-Weinberg, ultrasound of the abdomen and pelvis, intravenous pyelogram and computerized tomography (CT) scan. The Casoni's skin test and complement fixation test of Ghedini-Weinberg were performed when other preliminary tests were highly suggestive of hydatid disease. Upon making a diagnosis of renal hydatid disease, all patients underwent surgical exploration through a supracostal loin incision.
| Results|| |
The main clinical presentation was loin pain. In the absence of a pathognomonic laboratory test for renal hydatid disease except hydatiduria, the diagnosis in our study patients was mainly based on imaging techniques. Ultrasonography provided invaluable information in all cases about the location, size, and nature of the mass. Computerized tomography scan with contrast medium had the highest sensitivity and specificity; it gave us precise information about the location, size, site, content of the cyst and extent of renal cortical involvement [Figure - 1]. Also, it was very useful for follow-up. Intravenous pyelography (IVP) was of little value in the diagnosis of the disease due to lack of dimensional images
[Figure - 2] and [Figure - 3]. The serological tests were not positive in all cases (Table 1). The Casoni's skin test was positive in the first and the fifth patients, while the Ghedini-Weinberg test was positive in three patients. Urine analysis for hydatiduria was positive in only one patient.
The treatment offered to our patients was mainly surgical as shown in [Table - 1]. The supracostal, extra-peritoneal loin incision proved to be convenient in approaching the affected kidney for nephrectomy or nephron sparing operation (partial nephrectomy or cyst excision). Total nephrectomy was performed in five patients as the kidneys were found to be totally damaged, partial nephrectomy in two, and cyst excision was performed in one patient. The results of these surgical procedures were satisfactory and there were no intra-operative or early post-operative complications. The patients were followed-up for a mean period of 32 months and during this period, no recurrence of the disease, either locally or in the contra lateral kidney, were found.
| Discussion|| |
Hydatid disease is a human infection caused by the larval stage of Echinococcus granulosus. , Dogs are the principal definitive hosts and sheep are the most common intermediate hosts. Human infection is most common in sheep-raising areas of the world and virtually all parts of the human anatomy have been reported to have hydatid cyst.  The cyst usually grows slowly, taking years to reach a detectable size, and it remains asymptomatic as long as it is uncomplicated.  Definitive pre-operative diagnosis of a hydatid cyst of the kidney requires a high level of suspicion for the entity, since it usually mimics more familiar lesions of the kidney. There are no specific symptoms for the disease; it may cause loin pain, hematuria, pyuria, palpable mass or hydatiduria, which is seen when the cyst ruptures into the pelvis or calyces.  If the cyst develops secondary infection, fever or malaise may also occur.  Serological tests (Casoni's Skin test and Ghedini-Weinberg test) reflect an overall state of sensitivity to the hydatid antigen and have no clear-cut or useful correlation with the pathological state of the hydatid disease of the kidney. Eosinophilia is a non-specific marker of parasitic infestations. All these three tests when positive may help indicate further investigations and unfortunately when negative do not rule out hydatid disease.  Plain abdominal X-rays are usually inconclusive in diagnosing hydatid disease, even in the presence of visible calcifications. Ultrasonography usually allows differentiation of solid from cystic masses. The presence of daughter cysts is strongly suggestive of hydatid disease.
A CT scan is more reliable than ultrasound. Hydatid disease is definitely diagnosed if scoleces, hooklets or fragments of the parasitic membrane are found in the urine.
The main line of treatment for renal hydatid disease is surgical, either cyst excision or nephrectomy. Other modalities of treatment have also been recommended, such as medical treatment with albendazole and mebendazole, percutaneous drainage of renal hydatid cyst with albendazole, , and surgical drainage with pedicle omentoplasty.  Spillage of cyst fluids can cause anaphylactic reaction or contamination with scoleces that can produce metastatic cysts, so dissection must be done carefully to avoid rupture. We did not encounter any case of anaphylactic reaction during surgery and manipulation, and to avoid it, dissection was performed in a meticulous way in addition to using abdominal pads that were soaked in hypertonic saline around the organ. In our study, we performed nephrectomy in five patients, cyst excision in two, and partial nephrectomy in one. Our preference to surgical mode of treatment is in accordance with other groups as well including Gogus et al,  Zmerli et al,  and Angulo et al  . The higher proportion of nephrectomy, as treatment option, in our group was due to the presence of large sized hydatid cysts with massive cortical involvement resulting in inability to do nephron-sparing operations.
Our report suggests that main line of treatment of hydatid disease of the kidney still remains surgical in the form of either nephrectomy or nephron-sparing operations, and CT scan is the most useful diagnostic tool.
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Adnan A Abu-Qamar
Department of Urology, Queen Rania Urology Center, King Hussein Medical Center, P.O.Box 201, Amman 11953, Amman
[Figure - 1], [Figure - 2], [Figure - 3]
[Table - 1]