Giant Hydronephrosis: A Rare Case Report and Literature Review

Abstract

Giant hydronephrosis (GH), characterized by the presence of more than 1 L of fluid in the renal collecting system, is a rare urological condition, particularly in adults. Obstruction of the pyeloureteral junction is the most common cause of GH. We report the case of a 51-year-old man who presented with dyspnea, edema of the lower limbs, and major abdominal distension. The patient was diagnosed with obstruction of the pyeloureteral junction, causing a left giant hydronephrotic kidney. After renal drainage of 27 L of urine, a laparoscopic nephrectomy was performed. GH usually manifests as asymptomatic abdominal distension or vague symptoms. However, very few published reports describe cases of GH initially presenting with respiratory and vascular manifestations.

A giant hydronephrosis disguised as abdominal obesity

“…Clinical symptoms may include vague abdominal distension, hematuria, abdominal pain, recurrent urinary tract infection, secondary hypertension, and renal failure. The pressure on the renal tubules can lead to intrarenal ischemia, which may result in secondary polycythemia 1,2 …”

“…The pressure on the renal tubules can lead to intrarenal ischemia, which may result in secondary polycythemia. 1,2 It is important to consider fat, fluid, feces, fetus, and flatus (5 F's) while evaluating abdominal distension. This case highlights the importance of a thorough clinical examination and a low threshold for imaging while evaluating causes of abdominal distension other than obesity.…”

“…The pressure on the renal tubules can lead to intrarenal ischemia, which may result in secondary polycythemia. 1 , 2 …”