Females produce eggs which are passed in urine. In aquatic environments, eggs embryonate after 15–100 days. These eggs are ingested by an aquatic oligochaete, hatch, penetrate blood vessels, and develop into a stage three larvae. A paratenic host may then ingest the oligochaete. The oligochaete or paratenic host is then eaten by a definitive host, wherein juveniles penetrate intestinal lining and migrate to the liver. After maturing for approximately 50 days, the juveniles then migrate to the kidneys (typically the right kidney). Upon maturation, D. renale can survive for five years. Definitive hosts are carnivorous mammals, notably mink, but also includes wolves, coyotes, foxes, dogs, raccoons, and weasels. Transmission to humans typically occurs upon ingestion of raw or undercooked freshwater fish or frog. There are multiple reservoirs for D. renale. Confirmed cases of infection have occurred in minks, dogs, swine, bears, oxen, and humans. MorphologyD. renale is the largest nematode to parasitize humans. Adult male worms are 20–40 cm long and 5–6 mm wide; females can grow to 103 cm in length with a width of 10–12 mm. Both sexes appear bright red in color and taper at both the anterior and posterior ends. Male D. renale worms have a bursa, which is used to attach to facilitate mating. Eggs are 60–80 micrometres x 39–47 micrometres, contain an embryo, and have characteristic sculpturing of the shell. They have an oval-shape and brownish-yellow hue. Eggs have a thick shell, and the surface appears to be pitted except at the poles. Diagnosis The only means of obtaining a definitive diagnosis is through the identification of D. renale eggs in a patient's urine. However, obtaining patient history (i.e., if the patient has consumed undercooked or raw freshwater fish) is an important first step that can be coupled with radiological exams to search for enlarged or calcified kidneys. Urinalysis will likely show hematuria blood tests may reveal eosinophilia. Management Likely because of the rarity of human cases, there is no standard treatment for D. renale infection in humans. The only known means is surgical excision of either adult worms or the infected kidney. Nephrectomy is generally considered extreme for human cases. A physician reportedly used Ivermectin to treat a patient, who was effectively cured. The use of anti-helminth drugs has not yet been evaluated as the proper course of action to treat this infection. Epidemiology Though D. renale is distributed worldwide, though markedly less