Isolated renal hydatid disease in a non-endemic country: a single centre experience

Abstract

Objective: Isolated renal hydatid disease (HD) is rare in nonendemic countries. Clinical and radiological suspicion warrants appropriate serological tests, preoperative treatment and intra-operative precautions. We present a tertiary care centre experience of isolated renal HD in a non-endemic country. Methods: We reviewed the medical records of patients with HD treated in the past 20 years. We identified patients with the definitive diagnosis of isolated renal HD and described their management. Results: Of the 119 cases with HD, 6 were found to have isolated renal involvement (5%). Their median age was 46.5 (28-70) years. Five patients presented with flank pain and 1 had an incidentally discovered renal mass. Radiologic investigations raised the suspicion of possible HD in 4 cases, while 2 cases were diagnosed as renal tumours. Computerized tomography showed complex renal cyst in 4, solid renal mass with heterogonous enhancement in 2 and calcification in 5. Eosinophilia and indirect hemagglutination test (IHA) were positive in 3 of the 4 suspected cases. Three cases were treated as renal tumours, while 3 were managed as HD. Four cases had total nephrectomy and 2 had partial nephrectomy. Histopathology revealed that all cases had renal HD. Patients were followed for a median of 7.3 (0.4-11.3) years with no evidence of recurrence. Conclusions: Isolated renal HD is a challenging preoperative diagnosis in non-endemic countries. The definitive diagnosis is only possible by histopathology. Retrospectively, HD mimicked renal tumours in half the cases and should be considered in the differential diagnosis of renal space occupying lesions. RésuméObjectif : L'hydatidose rénale isolée est une maladie rare dans les pays où elle n'est pas endémique. Des éléments cliniques et radiologiques suspects justifient des tests sérologiques appropriés, un traitement préopératoire et des précautions peropératoires. Nous présentons l'expérience d'un centre de soins tertiaires avec l'hydatidose rénale isolée dans un pays où cette maladie n'est pas endémique.Méthodologie : Nous avons passé en revue les dossiers médi-caux de patients atteints d'hydatidose au cours des 20 dernières années. Nous avons cerné des patients ayant reçu un diagnostic final d'hydatidose rénale isolée et nous décrivons leur traitement. Résultats : Sur les 119 cas d'hydatidose, 6 avaient une atteinte rénale isolée (5 %). L'âge médian de ces patients était de 46,5 ans (28 à 70). Cinq patients présentaient des douleurs au flanc, et un patient présentait une masse rénale découverte fortuitement. Des examens radiologiques ont fait hausser les soupçons quant à une hydatidose dans quatre cas, alors que dans les deux autres cas, on a diagnostiqué une tumeur rénale. La TDM a montré un kyste rénal complexe chez quatre patients, une masse rénale solide avec densification hétérogène dans deux cas et des calcifications dans cinq cas. L'éosinophilie et le test d'hémagglutination passive étaient positifs dans trois des quatre cas soupçonnés. Trois cas ont été traités comm...

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