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Renal Forniceal rupture is a common urological emergency, most commonly due to an underlying ureteral obstruction. There is no standardized management for forniceal rupture. We report a 70-year-old female who presented with vague abdominal symptoms, and acute on Chronic Kidney Disease. Plain Computed Tomography scan of the abdomen/pelvis revealed grossly disturbed renal anatomy, with a large perinephric collection, and an obstructing pelvic-ureteric junction stone. She was initially managed with intravenous antibiotics, percutaneous drain and percutaneous nephrostomy placement. She subsequently underwent right flexible ureteroscopy and double-J stenting. Prompt, early intervention resulted in return of renal anatomy and facilitated early recovery.

Multifocality in renal tumors is a rare occurrence, but not unheard of. Commonly the different foci correspond to the same histological pathology, however co-existence with other renal lesions, including both malignant and benign tumors, have also been reported. Here we present a 57-year-old male, ex-smoker who exhibited four distinct histological tumors in an ipsilateral kidney; multilocular cystic clear cell renal cell carcinoma (RCC) of low malignant potential, clear cell papillary RCC, renal oncocytoma, and renomedullary interstitial cell tumor. To our knowledge this is the first time these four tumors were found in the same patient, let alone the same kidney.