Missed Diagnosis Analysis and a Literature Review of Solitary Kidney Patient with Renal Calculus Combined with Transitional Cell Carcinoma of Renal Pelvis and Calices

WANG Zhi-chao; ZHOU Jian-fu; GUI Ze-hong; XIE Min-jun; WANG Shu-sheng; XIANG Song-tao

doi:10.3969/j.issn.1002-3429.2017.09.011

Abstract：Objective To investigate key points of diagnosis and treatment for solitary kidney patients with renal calculus combined with transitional cell carcinoma of renal pelvis and calices.Methods Clinical data of 1 solitary kidney patient with renal calculus combined with transitional cell carcinoma of renal pelvis and calices was retrospectively analyzed, and related literature was reviewed.Results The patient was admitted for right low back vague pain for more than 10 years and aggravation associated by macrohematuria for 1 week.The patient was diagnosed as having right kidney, solitary kidney and kidney stones 10 years ago, and underwent right kidney of nephrolithotomy.The calculus was recurred 1 year later without being treated.After admission, laboratory and iconography examinations were performed, and the diagnosis of solitary kidney combined with renal calculus was given.Right kidney of percutaneous nephrostolithotomy (PCNL) was performed under tracheal cannula and general anesthesia, and a cauliflower-like solitary neoplasm with 1 cm fundus width was discovered in middle kidney calices, and postoperatively pathological report showed low-grade noninfiltrating uroepithelium transitional cell carcinoma.After the family had agreed, percutaneous nephroscope examination and holmium laser tumor ablation hemostasis were given, but bleeding could not be stopped during operation, and then solitary nephrectomy was performed, and regular hemodialysis treatment was given after operation.With 7 months of follow-up, creatinine level fluctuated at 350-590μmol/L without recurrence of low back pain.Conclusion Solitary kidney patients with renal calculus combined with transitional cell carcinoma of renal pelvis and calices is rare in clinic, and therefore it is easily misdiagnosed.Individualized treatment should be given on the basis of patient''s condition because of complex condition.