Spontaneous renal pelvis perforation in an adolescent with a solitary kidney.

BACKGROUND: Spontaneous renal pelvis perforation is a rare but serious condition, often associated with urinary obstruction, infection, or increased intrapelvic pressure. Here, we present a pediatric patient with a solitary kidney who developed this rare condition. CASE PRESENTATION: We report the case of a 14-year-old girl with a solitary kidney who presented with abdominal pain, vomiting, and anuria. Laboratory findings revealed acute kidney injury, requiring emergent hemodialysis. Imaging studies demonstrated a spontaneous perforation in the anteromedial renal pelvis. The patient was initially managed with antibiotics and a double-J (DJ) ureteral stent. However, persistent fever and worsening retroperitoneal fluid collection necessitated percutaneous abscess drainage. Despite initial clinical improvement, she later developed recurrent urine leakage due to DJ stent occlusion, which required percutaneous nephrostomy placement. At the three-month follow-up, spontaneous resolution of the perforation was confirmed, and the patient was diagnosed with stage 4 chronic kidney disease. CONCLUSIONS: Spontaneous renal pelvis perforation remains a rare entity in the pediatric population, with limited cases documented in the literature. This case emphasizes the importance of early recognition, timely imaging, and appropriate urinary drainage to prevent long-term renal impairment. In pediatric patients with a solitary kidney, close monitoring and a multidisciplinary approach are crucial to optimizing outcomes.