Renal Hydatid Cyst Detected in a Child during the Course of Acute Poststreptococcal Glomerulonephritis

Dr. Ayşe Öner, GATA Lojmanlari, Saǧlam Apt., 23/11, Etlik, TR-Ankara (Turkey) Dear Sir, Being a developing country, Turkey is endemic for echinococcosis, and other infections and their complications like acute poststreptococcal glomerulonephritis (APSGN) are also frequently seen. We present here a child who was diagnosed, during the course of APSGN, to have a renal hydatid cyst. The coincidental occurrence of these two renal disorders in the same patient at the same time has not been reported before. A 15-year-old boy was admitted to the hospital because of syncope and edema lasting for 1 day following an upper respiratory tract infection. The physical examination revealed a welldeveloped lethargic boy with pretibial edema and hypertension (240/120 mm Hg). His fundoscopic examination was normal. A palpable solid mass of 5-6 cm diameter was found in the right hypochon-drium. The laboratory examination showed: hemoglobin 13 g/dl, white blood cell count Π‚OOO/mm3 with 8% eosinophils in peripheral blood smear; proteinuria (++) and microscopic hematuria with red blood cell casts. Blood urea nitrogen was 42 mg/dl (14.9 mmol/l), serum creatinine 1.8 mg/dl (159.12 mmol/l); total protein, albumin, electrolyte levels and liver function tests were normal. The antistreptolysin-0 titer was elevated (833 TU), C-reactive protein was 3+, the third component of complement (C3) level was < 20 mg/dl (normal: 50-90 mg/dl), and C4 was 23.8 mg/dl (normal: 10-40 mg/dl). Due to clinical and laboratory findings, the patient was diagnosed as suffering from APSGN and was treated with antihyperten-sive and diuretic drugs. Abdominal ultraso-nography showed a round cystic mass of 78x55x52 mm in size in the lower pole of the right kidney, which was also demonstrated by computerized tomography. The hemaggluti-nation test for Echinococcus was found to be positive (1/256). One month after admission percutaneous treatment of the hydatid cyst was performed under ultrasonographic guidance [ 1 ]. No complication occurred. Ultrasonographic examination during and after treatment revealed linear echogenic floating structures which represent the separated endocyst (germinative and laminated membranes) in