Unilateral Renal Cystic Disease - A Rare Entity
A 45 year old female was referred from the department of Surgery for abdominal ultrasound complaining of pain in the left flank. She had been experiencing mild to moderate pain in the left flank region since several years. There is no history of gastrointestinal, cardiovascular or urological symptoms (including hematuria). Family history did not reveal any other member as having similar complaints. On physical examination, a mass measuring approximately (6x5) cm was palpated in the left flank region. All the preliminary investigations done were normal, including blood pressure (120/80 mm Hg), specific gravity of urine (1.015), hemoglobin (13gm/dl), RBC count (4 trillion cells/L), total WBC count (8 billion cells/L), platelet count (200 billion cells/L), serum urea (30mg/L), serum creatinine (1.1mg/dl) and blood urea nitrogen (18 mg/dl) along with echocardiography and colon examination. Ultrasound scan revealed enlarged left kidney with lobulated renal outline, replaced by multiple well defined to ill defined anechoic areas of varying sizes, separated by thin septae, partially sparing the lower lobe, suggestive of multiple anechoic renal cysts. On Computed Tomography the left kidney was enlarged with lobulated renal outline, completely replaced by hypodense areas of varying sizes with loss of cortico-medullary differentiation. On contrast enhanced Computed Tomomgraphy, the hypodense lesions came out to be non enhancing, whereas the normal residual renal parenchyma had normal enhancement pattern with no evidence of any abnormally enhancing lesion. Para-renal fascia and renal capsule were completely intact with no evidence of either fat stranding or collection in the surrounding area. The right kidney was seen to be normal in size and shape with maintained cortico-medullary differentiation and normally enhancing parenchyma. The subject maintained a good renal function for a period of six months, revealed by serial ultrasound examinations and renal function tests, documenting stability of the disease.