RENAL ECHINOCOCCOSIS - CLINICAL-STUDY OF 34 CASES

Purpose: Hydatid disease, a cyclo-zoonotic parasitic infestation cause d by the larval stage of the cestode Echinococcus granulosus, is preva lent worldwide. We reviewed the clinical findings of a large series of renal hydatidosis treated in an endemic area with special emphasis on diagnostic pitfalls. Materials and Methods: A retrospective 15-year r eview in a rural area of central Spain (600,000 population), with a gl obal incidence of hydatidosis of 10 new cases per 100,000 population p er year, revealed 34 with renal echinococcosis treated surgically (3 t o 4% of officially confirmed cases of hydatidosis). Clinical, radiolog ical and laboratory data were analyzed. Results: Renal hydatid disease mimicked other diseases. The combination of clinical history, imaging studies, and serological and urine investigation yielded a reliable p retreatment diagnosis in only 50% of cases and a presumptive diagnosis in 71%. Among imaging studies computerized tomography was the most va luable diagnostic examination. Moderate eosinophilia was found in half of the cases, while a third had scoleces in the urine. A diagnostic a nd therapeutic algorithm is presented. Conclusions: Preoperative diagn osis of renal hydatid disease is difficult even in an endemic zone. Im aging studies are suggestive but usually inconclusive, and the differe ntial diagnosis with a renal tumor or complicated cyst may not be made without surgery. Renal sparing surgery is possible in a significant p roportion of cases, particularly when preoperative diagnosis has been considered. Significant surgical morbidity can be expected, and the ri sk of anaphylaxis and hydatid seeding, although low, should not be ove rlooked.