![]() ![]() Urolithiasis causes renal obstruction and failure, such as either acute kidney injury with or without anuria which indicates urgent urological intervention or a chronic form of bilateral severe hydronephrosis. ![]() After 1.5 months, a right middle ureterolithotomy was done through a small muscle-splitting Abernathy incision. Right and left split renal functions were 21.2 (38.8%) and 33.4 (61.2%) mL/min/1.73 m 2, respectively. Three weeks later, mercaptoacetyltriglycine (MAG3) renal isotope scanning was done and revealed a total glomerular filtration rate of 54.6 mL/min/1.73 m 2. Third-generation cephalosporin was started preoperatively and continued for 7–10 days according to the culture of this drained fluid which also revealed E. Accordingly, left renal stones were cleared via a left pyelolithotomy with drainage of more than 1 L of urine and insertion of a left JJ stent, with simultaneous placement of a right nephrostomy tube which gradually drained about 2.2 L of slightly turbid urine. Owing to financial considerations, she preferred open surgery. The patient and accompanying relatives were counselled about the critical condition of her renal functions and the available lines of treatment of these stone burdens. Accordingly, a right ureterolithotomy was done and the patient was followed up for 1 year with variable serum creatinine level between 1.2 and 1.5 mg/dL. Then, renal isotope scanning revealed diminished total glomerular filtration rate (54.6 mL/min/1.73 m 2) with better left split function (61.2 vs. After counselling of the patient, simultaneous left pyelolithotomy with placement of a left JJ stent and right nephrostomy tube were done. The left kidney had variable parenchymal thickness which was better at the lower pole with multiple stones. Imaging revealed hugely dilated kidneys with right severe hydronephrosis and lost renal parenchyma due to a large middle ureteral stone. Urine analysis showed 60–80 pus cells/HPF and serum creatinine level was 1.2 mg/dL. She had a visible right renal mass with smooth surface and cystic consistency. We report on a 75-year-old female patient who presented with right-sided abdominal pain. In adulthood, however, other etiologies such as urolithiasis may supervene. Giant hydronephrosis is rare and usually presents during childhood as a unilateral renal mass due to congenital anomalies such as pelvi-ureteral junction obstruction. ![]()
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