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Volume 27, Issue 131, January 2023

Concomitant existence of malignant pathology in one kidney and benign pathology in the contralateral kidney, staged management to preserve maximum kidney function: An unusual case report

Anil Reddy¹, Jay D Dharmashi², Abhijit Dhale², Suhas Jajoo³, Chandrashekhar Mahakalkar⁴, Garima Saxena¹

¹Jr Resident Department of General Surgery (3RD year), Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India
²Professor and Urologist, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India
³Professor and Plastic surgeon, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India
⁴Professor and General surgeon Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India

ABSTRACT

Patients may have benign disorders such pelvic ureteric junction blockage, renal stone, angiomyolipoma, or renal cyst as well as unilaterally or bilaterally symmetrical malignant conditions like renal cell carcinoma sarcoma. But it is an uncommon occurrence to be presented when malignant pathology occurs in one kidney and benign pathology in the opposite kidney in the same patient. Since the presentation is uncommon, each kidney pathology must be managed stage-by-stage in order to maintain optimum renal function. Our patient, a 40-year-old woman, complained of stomach pain and frequent vomiting for seven to ten days when she first came in. Upon clinical examination, a palpable, non-tender mass was seen in the left lumbar area. An abdominal and pelvic ultrasound (USG) reveals a solid mass measuring 6.8 x 6 cm in the right kidney's upper pole with doppler vascularity indicative of a renal tumour and a left kidney pelvic ureteric junction blockage with extensive hydronephrosis. CECT Abdomen: A right-sided heterogeneously enhancing soft tissue renal mass measuring 72 x 63 x 62 mm (trans x ap x cc) arising from the upper pole on the CECT scan, along with pelvic-ureteric junction obstruction in the left kidney (UPJO). To retain the maximum amount of kidney function, the patient underwent staged surgical treatment. The main reason to report this case is as we have a patient with a malignant condition in one kidney and with a benign condition in the contralateral kidney. It is an unusual presentation and such a patient requires staged surgical management for the better preservation of both kidneys' functions.

Keywords: Renal Tumor, PUJO, Partial Nephrectomy, Anderson-Hynes dysmembered pyeloplasty, DJ stent