CASE 666: GIANT HYDRONEPHROSIS, Dr PHAN THANH HẢI, Dr TRẦN NGÂN CHÂU, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 53 year-old male patient with a painless big abdomen was accidentally detected having a right giant hydronephrosis via ultrasound examination. 

As the right dilated kidney was in large size that could not use any classic section to find out the clue of the renal obstruction. But in going down  from the left pelvis and toward right side, ultrasound revealed an evident ureteral stone # 20 milimeter.

Later, MSCT confirmed easier than ultrasound the 20 mm right ureteral stone which caused the right giant hydronephrosis.

The patient went through a right nephrostomy in emergency situation. About 4.5 liters of urine was drained out and then his abdomen getting flatten.

Two weeks later was done an evaluation of the right kidney function via Tc-99m DTPA scan. Ultrasound re-examination noted a distortion of right kidney structure: thickness of renal cortex thinner than 6 millimeter and nonexistent differentiation of renal medulla from cortex of renal parenchyma.

Via endoscopy  right nephrectomy was performed as the right disfunction kidney. 

6 months later value of eGFR rised from 64 to 75 mL/min/1.73m2 , and the patient remains well.