Idiopathic renal replacement lipomatosis: A diagnostic chall
The present case has been published in the Turkish Journal of Surgery. A 45-year-old woman presented with complaints of dull aching pain in the left flank of 2 years without any urinary complaints. The patient was obese with no positive findings on clinical examination duration, except for minimal left renal angle tenderness only on deep pressure.

Patients' blood and biochemical investigations were within normal limits. Ultrasound of the abdomen and pelvis could not provide any clue toward a definitive diagnosis other than showing a distorted contracted left kidney.

CT scan of the abdomen revealed distorted, shrunken left kidney with the thinned-out cortex. There was loss of corticomedullary differentiation and delayed excretion of contrast. The kidney was surrounded by perinephric fat, which had pushed the abdominal organs inferiorly and medially.

This information did not help in a definitive preoperative diagnosis. Hence, the retroperitoneum was explored through a flank incision to find a fatty mass in the left renal fossa.

Due to the densely adherent mass in that region, the surgeons performed a subcapsular nephrectomy to retrieve a contracted and distorted fatty mass with very little vascularity, which could be recognized as the kidney only by the fact there were some structures of the pelvicalyceal system in the region of renal sinus and its connection to the ureter.

Histopathological examination revealed total replacement of the renal parenchyma with fat with very few sclerosed glomeruli with thyroidized tubules.

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