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Background The uniqueness of this case is in its rarity and divergent presentation. Case presentation Here, we report a case of 56-year-old male patient with pain in the left flank for 1 year. On evaluation, patient was diagnosed with multiple left renal calculi and emphysematous pyelonephritis with non-functioning kidney. Intraoperatively, dense perinephric adhesions, necrotic kidney and renocolic fistula were encountered. The patient underwent left nephrectomy with resection anastomosis of descending colon segment with loop ileostomy. Histopathological examination showed a poorly differentiated high-grade clear cell carcinoma with squamous metaplasia. Conclusion Renal cell carcinoma can present in unusual ways. Sometimes, it can mimic emphysematous pyelonephritis because of fistulous communication with gut. It is rare but challenging for urologists to diagnose and manage such cases.

Background: Renal stone disease is a recognized precursor for renal deterioration, if untreated, it can lead to renal failure. With advances in the PCNL, the effect on patients with established renal insufficiency remains under reported. So, we aimed to evaluate the efficacy as well as safety of PCNL in chronic kidney disease patients.Methods: This retrospective cohort study included patients admitted in our hospital from January 2016 to December 2018, which were diagnosed with urolithiasis and chronic kidney disease and treated by PCNL. Patients with GFR <60 ml/min/1.73 m2 in non-obstructed renal stone disease who underwent PCNL were included. We studied the change in renal function, complete stone free rate (SFR) complications stone composition, operative time and hospital stay.Results: The study comprised 50 patients (M/F-32/18) of CKD who underwent PCNL. Mean operative time was 90.50±12.57minutes in group 1 and 98.00±12.35 minutes in group 2. One or more complications were noted in 12 patients (24%) after PCNL. At a mean follow-up of 18 months, renal function stage had improved in 24 patients (48%) and it was maintained in 13 (26%). Worse CKD with an increase in disease stage was noted in 13 patients (26%). Association between hypertension, diabetes and postoperative deterioration in kidney function wasn’t significant statistically (p=0.9). The stone-free rate at postoperative month 3 was 76%.Conclusions: PCNL has a favourable outcome in patients with chronic kidney disease stage III/IV, with a good calculus clearance rate and improved kidney function.

Multilocular cystic renal cell carcinoma (RCC) is a tumor of low-grade malignant potential which is curable by surgical resection. Here, we report a case which was incidentally detected during evaluation of right flank pain. It’s very challenging to differentiate such lesions from conventional clear cell carcinoma. However, it has good prognosis and amenable to surgical resection.