Destruction Of Renal Parenchyma Research Articles

Clinicopathological spectrum of xanthogranulomatous pyelonephritis; a single-center experience over 7 years

Background: Xanthogranulomatous pyelonephritis (XGP) is chronic pyelonephritis subtype where in renal parenchymal destruction occurs and therefore results in progressive loss of kidney functions. Although middle age group is the predominant age group affected but it can be seen at any age. There is accumulation of macrophages (lipid-laden) leading to renal parenchymal destruction and fibrosis. In this study, we present our data of 15 patients who had undergone nephrectomy and were biopsy proven XGP. Aims and Objectives: The aim of the study was to describe the clinical and radiological features of XGP in adults. Materials and Methods: XGP constituted 4.31% of the 348 nephrectomies done for infective causes over a period of 7 years. All our patients had undergone unilateral total nephrectomy. Demographic and clinical records were analyzed after consent from all the patients. Results: The age range in our study was 18–65 years with mean 42.93±15.66 years. Nine of our patients, that is, 60% were females. Diabetes was present in 53.3% of our patients. Three patients had imaging suggestive of pyonephrosis, three patients had perinephric collection and 9 patients (60%) had concomitant nephrolithiasis. All the kidneys were grossly enlarged and were non-functional on renal scintigraphy. Conclusion: XGP is a form of chronic pyelonephritis which although being less common but is devastating given the destruction of renal parenchyma it does and associated morbidity. Clinicoradiologic correlation cannot be overemphasized. The definitive diagnosis is established after histopathologic examination.

Clinicopathologic Spectrum of Xanthogranulomatous Pyelonephritis: A Single Center Experience over 8 Years

Xanthogranulomatous pyelonephritis (XGP) is a chronic pyelonephritis subtype in which destruction of the renal parenchymal occurs, resulting in progressive loss of kidney functions. Although middle age is the predominant age group affected, but it can be spotted at any age. There is accumulation of macrophages (lipid-laden), leading to renal parenchymal destruction and fibrosis. In this study, we present our data of 15 patients who had undergone nephrectomy and had biopsy-proven XGP. XGP constituted 4.53% of the 331 nephrectomies performed for infective causes over a period of 8 years. All our patients had undergone unilateral total nephrectomy. Demographic and clinical data were analyzed after taking consent from all the patients. The age range of patients in our study was 18–65 years with a mean age of 43.93 ± 13.86 years. Ten (66.6%) of our patients were females. Diabetes was present in 40% of the patients. Three patients had imaging, suggestive of pyonephrosis, 3 had perinephric collection and 9 patients (60%) had concomitant nephrolithiasis. All the kidneys were grossly enlarged and were nonfunctional on renal scintigraphy. XGP is a form of chronic pyelonephritis, which, although less common, is devastating because of destruction of the renal parenchyma and associated morbidity. Clinicoradiologic correlation cannot be overemphasized. Definitive diagnosis is established through histopathologic examination.

Pyonephrosis complicated with pleural empyema – case report

Pyonephrosis is defined as the infection of the dilated renal collector system, with a variety of etiological agents. The accumulation of pus may cause the destruction of renal parenchyma, leading to renal insufficiency. The symptoms may occur early or late in the disease’s progress and can be of a great variability. We present a case report of a 53-year-old female which suffered of low back pain, fever and nausea. The ultrasound and CT examination revealed 4th stage pyonephrosis caused by stone obstruction. It was also observed right encysted pleural empyema and pericardial fluid as pyonephrosis’ complications. The first part of the treatment consisted of inserting a percutaneous nephrostomy (PCN) probe along with the administration of antibiotics for the next two months, followed by radical right nephrectomy in renal insufficiency context. The postoperative evolution was favorable with no repercussions.

Renal artery embolization post subtotal nephrectomy for xanthogranulomatous pyelonephritis: A case report

Xanthogranulomatous pyelonephritis (XGPN) is a rare, chronic disease characterized by the destruction of renal parenchyma and replacement with granulomatous tissue and is associated with long-term obstructive uropathy, chronic renal parenchymal infection, and nephrolithiasis. A 57-year-old patient with XGPN was unable to undergo total nephrectomy. Renal artery embolization (RAE) was performed post subtotal nephrectomy as adjunct therapy to prevent urine formation and decrease the risk of post-operative infection. Our case report demonstrates that RAE can be performed safely and effectively without evident complications and underscores the utility of cone-beam computed tomography in cases of altered post-surgical anatomy. To the author’s knowledge, this is the second case in the literature demonstrating perioperative management of XGPN with RAE.

Bilateral diffuse xanthogranulomatous pyelonephritis in end-stage renal disease (ESRD).

Xanthogranulomatous pyelonephritis (XGP) is a very rare form of kidney disease characterized by destruction of renal parenchyma, its fibrosis, and its replacement by lipid-laden macrophages. ,. We describe a case of a 46-year-old woman with bilateral staghorn stones and end-stage renal disease (ESRD) under renal replacement therapy by hemodialysis. An abdominal CT scan suggested bilateral XGP () and she was submitted to bilateral nephrectomy. Histopathological analysis confirmed the diagnosis. […] Bilateral diffuse xanthogranulomatous pyelonephritis in end-stage renal disease (ESRD)

Pentraxin 3 – possible uses in neonatology and paediatrics

Pentraxin 3 (PTX3) is a multifunctional acute phase protein belonging to the family of long pentraxins, which is synthesised in numerous cells of the body under the influence of proinflammatory factors and locally at the site of inflammation. Under physiological conditions, PTX3 is stored in neutrophil granules, where there is a constant pool of glycoproteins. Increased pentraxin 3 levels in blood serum are observed as early as 1 hour after a damaging stimulus. Elevation of PTX3 serum levels can be used to diagnose fertility disorders in women as well as in pregnancy pathology, women at risk of pre-eclampsia, gestational diabetes, premature rupture of membrane and preterm delivery. The biological function of PTX3 is not fully understood, especially in the population of newborns and children. So far, no reference values for PTX3 levels in newborns and children have been developed. This protein can be used as a marker of pulmonary hypertension in newborns as well as to assess the degree of respiratory failure in premature infants. In older children, it is useful in the assessment of the severity of meningococcal disease and sepsis as well as in the treatment of childhood asthma. There are studies available in which blood levels of PTX3 significantly correlate with the severity of kidney damage in Henoch–Schönlein macular degeneration in children, and the evaluation of this protein in urine is used to detect renal parenchymal destruction after pyelonephritis.

Emerging Roles of Long Non-Coding RNAs in Renal Fibrosis.

Renal fibrosis is an unavoidable consequence that occurs in nearly all of the nephropathies. It is characterized by a superabundant deposition and accumulation of extracellular matrix (ECM). All compartments in the kidney can be affected, including interstitium, glomeruli, vasculature, and other connective tissue, during the pathogenesis of renal fibrosis. The development of this process eventually causes destruction of renal parenchyma and end-stage renal failure, which is a devastating disease that requires renal replacement therapies. Recently, long non-coding RNAs (lncRNAs) have been emerging as key regulators governing gene expression and affecting various biological processes. These versatile roles include transcriptional regulation, organization of nuclear domains, and the regulation of RNA molecules or proteins. Current evidence proposes the involvement of lncRNAs in the pathologic process of kidney fibrosis. In this review, the biological relevance of lncRNAs in renal fibrosis will be clarified as important novel regulators and potential therapeutic targets. The biology, and subsequently the current understanding, of lncRNAs in renal fibrosis are demonstrated—highlighting the involvement of lncRNAs in kidney cell function, phenotype transition, and vascular damage and rarefaction. Finally, we discuss challenges and future prospects of lncRNAs in diagnostic markers and potential therapeutic targets, hoping to further inspire the management of renal fibrosis.

A clinicopathological study of Xanthogranulomatous pyelonephritis

Introduction: Rare, severe and atypical form of chronic pyelonephritis characterized by destruction of renal parenchyma and the presence of granulomas, abscesses, and collection of lipid filled macrophages. Objective: To study the clinicopathological relationship of the lesion. Method: A 8 year retrospective study was done to analyze the lesions of renal and ureteric calculi. XGP was found to be most common in female. Conclusion: Xanthogranulomatous pyelonephritis is unusual variant of chronic pyelonephritis. Preoperative diagnosis is desirable with laboratory analysis. Histopathological examination is important to know the type and etiological factor of the lesion.

Urological infections in the developing world: an increasing problem in developed countries.

Infectious diseases that often follow geographical distribution patterns are increasingly crossing such boundaries, aided by human travel and commerce. These pose a new challenge to physicians who are required to diagnose previously unseen conditions and address drug-resistant organisms. We review some such common infections. A literature review was performed for six common urological infections and a narrative review based on recent publications on these infections was compiled. In Urology, some infections that are now crossing geographical boundaries include Brucellosis, Schistosomiasis, Tuberculosis, Filariasis, Hydatidosis and emphysematous pyelonephritis. Brucellosis, a zoonotic infection, is common in the Mediterranean areas, Asia, South America and Africa. Infection can involve all parts of the genitourinary tract. Schistosomiasis, a parasitic disease, is particularly common in Sub-Saharan Africa and may have bacterial superinfection. Voiding symptoms are common and bladder carcinoma may develop. Tuberculosis affects almost every organ in the body and in the male genital system, often presents with abscesses, nodules, ulcers and infertility that is difficult to manage. Filariasis is caused by two species of worms and is transmitted through a bite from a mosquito carrying larvae of the worm. It causes lymphatic obstruction leading to scrotal edema, hydrocoele to elephantiasis of scrotum. Emphysematous pyelonephritis is a life-threatening suppurative necrotizing infection of the renal parenchyma. While not being geographically limited, it is more common in developing areas with poor health care access. Genitourinary hydatidosis is a rare disease that is associated mainly with renal involvement in the genitourinary tract. Large cysts with destruction of renal parenchyma may be found. Although uncommon, these urological infections are associated with significant morbidity and mortality and awareness in all healthcare settings is now an essential requirement.

Septated fetal bladder in a case of 2q13 deletion

Abstract Objectives We aim to report a case of a septated urinary bladder with kidney dysplasia in a fetus presenting with 2q13 microdeletion. Several genes have been related to urogenital malformations. Reports of fetal multi-septated urinary bladder are extremely rare. Deletion 2q13 is responsible for a wide range of phenotypic manifestations but not commonly urogenital diseases. Case presentation We present a case of a primigravida with no contributing history referred to our center for suspected fetal kidney dysplasia. Ultrasound scan at 25 weeks gestation revealed septated urinary bladder and severe pelvic renal dilatation. CGH array showed de novo deletion 2q13. Upon counseling the parents opted for termination. Autopsy confirmed the urinary tract findings and normal external female genitalia. Conclusions To the best of our knowledge this is the first report of a 2q13 microdeletion and septated bladder. We suggest offering genetic counseling at the finding of a septated bladder and determine prognosis upon renal parenchymal destruction.

Management of Emphysematous Pyelonephritis and Subsequent Renal Functional Outcome

Background & objective: Emphysematous pyelonephritis (EPN) is an acute severe necrotizing infection of the renal parenchyma and its surrounding tissues that is caused by the presence of gas in the renal parenchyma, collecting system or perinephric tissue.The present study was intended to assess the functional status of the emphysematous kidney recovered from infection after treatment.
 Methods: This prospective study was conducted on 50 consecutive cases of emphysematous pyelonephritis, who were admitted in BIRDEM General Hospital from January 2011 to June 2012. Patients with EPN were selected after taking history, clinical examination and radiological image findings. Based on clinical parameter and radiological grading, patients were categorized for medical or surgical intervention. The forms of surgeries were open drainage or nephrectomy. Renal parenchymal destruction more than 50% on CT required nephrectomy.
 Results: The mean age of the patients at diagnosis was 47.5 ± 11.8 years (range: 26-70 years). The patients were predominantly female (82%), invariably diabetic and primarily presented with fever (88%) and loin pain (82%) followed by dysuria (60%). Over three-quarters (78%) of the patients had poor glycemic control (HbA1c >7%) and over half (54%) were classified as having class 1 or 2 disease and the rest had class 3 and 4 diseases. Escherichia coli was the commonest pathogen found in urine cultures (70%). Over half (56%) received medical treatment alone. In the surgical intervention group, patients were mostly toxic with spreading or severe localized infection, fever and were deteriorating or static even after three days of aggressive intravenous antibiotic treatment. Of the 22 patients who underwent surgery, nephrectomy was performed in 8(16%) and open drainage in 14(28%) cases. The overall survival rate was 94%. Average serum creatinine level was found to decrease gradually during follow up. The function of the preserved kidney was found to improve in the subsequent follow up.
 Conclusion: Emphysematous pyelonephritis predominantly affects diabetic females. Kidney preservation should be the primary target in treating EPN. Adequate resuscitation, diabetic control and parenteral antibiotic are the treatment of choice. Rapid drainage and nephrectomy should be performed in advanced stages. The focus of management of patients with emphysematous pyelonephritis should not only to improve survival but also salvage of the renal unit, for the affected kidney may still function once the infection is eradicated.
 Ibrahim Card Med J 2017; 7 (1&2): 57-63

Aspects of Evolving Genito Urinary Tuberculosis-A Profile of Genito Urinary Tuberculosis (GUTB) in 110 Patients.

Genito Urinary Tuberculosis (GUTB) is a widespread disease seen in urology practice. The true incidence and prevalence of GUTB is difficult to estimate because a large number of patients remain asymptomatic. To recognize typical and atypical clinical and radiological features of tuberculosis and to emphasize the need for diagnosing GUTB early. This was a retrospective study conducted in 110 cases of GUTB diagnosed and treated in two teaching institutions over a period of three years, from July 2002 to June 2005. A detailed history, thorough clinical examination, urine examination, culture for tubercle bacillus, imaging studies, cystoscopy and histological and serological examination were done to arrive at a diagnosis. Fifty six patients (51%) were in the age group of 21-40 years. The male: female ratio was 1.4: 1. Loin pain was the most common symptom observed in 27% of the patients. Intravenous Urogram (IVU) revealed non-visulalised kidney in 25 patients (23%), hydronephrosis or hydrouretero nephrosis in 34 patients (31%) and distortion, cavitation or scarring of the calyces in 16 patients (14.5%). Five of them had thimble bladder. In 14 patients, IVU appeared normal. About 28 patients (25%) were treated conservatively with anti tuberculosis therapy. Twenty one of them (19%) underwent Nephrectomy and 10 patients had reconstructive procedures. A peculiarity of most of our patients was a late presentation with advanced disease. Most patients were asymptomatic or ignorant. Slow but continuous infection causes a destruction of renal parenchyma and the healing process leads to renal parenchymal loss. If identified early and treated appropriately, GUTB is a curable condition.

The Role of Laparoscopic Nephrectomy in Pediatric Xanthogranulomatous Pyelonephritis: A Case Report

Xanthogranulomatous pyelonephritis (XGP) is a rare chronic renal infection characterized by the destruction of renal parenchyma. Traditional treatment involves open radical nephrectomy, which is challenging due to the inflammatory process associated with XGP. More recently, laparoscopic nephrectomy has been employed successfully in adult XGP. We present a case of a six-year-old female child with XGP who was successfully treated by laparoscopic nephrectomy with minor complications. Our case demonstrates the safety and feasibility of laparoscopic nephrectomy for childhood XGP, indicating that it should be considered a management option in such cases.

Emphysematous Pyelonephritis in a Patient With Hyperosmolar Hyperglycemic Syndrome

A 61-year-old woman presented with abdominal and back pain, and disturbed consciousness. Laboratory data showed hyperglycemia (plasma glucose 448 mg/dl), leukocytosis, thrombocytopenia, renal failure, and extremely increased serum C-reactive protein level. Urinalysis revealed no ketone bodies, and numerous bacteria and leukocytes. These symptoms and data suggested the presence of diabetic hyperosmolar hyperglycemic syndrome and urinary tract infection. Computed tomography (CT) of the abdomen showed the presence of gas in the renal area with extensive renal parenchymal destruction, indicating the diagnosis of emphysematous pyelonephritis, which is a rare but severe disease with a morality rate that can be as high as 70%. Early diagnosis by abdominal CT and early intensive therapy using intensive insulin therapy, antibiotics, and selective nephrectomy saved her life. doi:10.4021/jmc121w

Pyélonéphrite xanthogranulomateuse diffuse du nourrisson

We report a case of a renal mass in a 4-month boy, which occured during the assessment of a pelvi-calyceal dilatation diagnosed at 23 weeks of gestational age. There was no history of urinary infection, fever or weight loss. Physical examination revealed a mass of the left flank with significant flank tenderness. Laboratory test showed a biological inflammatory syndrome and urine culture was negative. Investigations including ultrasound and computed tomography scan were suggestive of diffuse xanthogranulomatous pyelonephritis with a non-functioning left kidney. Left total nephrectomy was performed through a lumbar incision with an extraperitoneal approach. The kidney was enlarged with a dilated pelvis containing pus upstream of a proximal ureteral atretic segment. Pathological examination of the kidney confirmed the diagnosis of diffuse xanthogranulomatous pyelonephritis. The boy remains well at 1 year follow-up. Xanthogranulomatous pyelonephritis is very rare in infants. It is an uncommon severe progressive renal infection resulting in destruction of renal parenchyma, histologically replaced by xanthomatous cells and granulomatous reaction. Pathogenesis of xanthogranulomatous pyelonephritis remains unclear. But it is well known that urinary tract obstruction and renal lithiasis are determining factors. It can occur in variant clinical forms but its symptoms remain non-specific. Curative treatment consists in nephrectomy and definitive diagnosis is made on histological examination of the kidney. This diagnosis should be discussed when a renal mass occurs in a context of malformative uropathy and xanthogranulomatous pyelonephritis have to be included in the differential diagnosis of renal mass in infants and children.

Emphysematous Pyelonephritis in a Patient With Hyperosmolar Hyperglycemic Syndrome

A 61-year-old woman presented with abdominal and back pain, and disturbed consciousness. Laboratory data showed hyperglycemia (plasma glucose 448 mg/dl), leukocytosis, thrombocytopenia, renal failure, and extremely increased serum C-reactive protein level. Urinalysis revealed no ketone bodies, and numerous bacteria and leukocytes. These symptoms and data suggested the presence of diabetic hyperosmolar hyperglycemic syndrome and urinary tract infection. Computed tomography (CT) of the abdomen showed the presence of gas in the renal area with extensive renal parenchymal destruction, indicating the diagnosis of emphysematous pyelonephritis, which is a rare but severe disease with a morality rate that can be as high as 70%. Early diagnosis by abdominal CT and early intensive therapy using intensive insulin therapy, antibiotics, and selective nephrectomy saved her life. J Med Cases. 2011;2(1):37-38 doi: https://doi.org/10.4021/jmc121w

Predictive factors for mortality and need for nephrectomy in patients with emphysematous pyelonephritis

To analyse the factors predicting the mortality and need for nephrectomy in patients with emphysematous pyelonephritis (EPN). Clinical features, laboratory variables, imaging studies, management strategy and the final outcomes were analysed in 39 consecutive patients with EPN. The mean (sd) age was 57 (7.2) years and the male to female ratio was 2:11. The baseline risk factors (clinical, laboratory and radiological) were compared among three groups; group 1, survived with renal salvage (26); group 2, survived after nephrectomy (eight); and group 3, died (five). The overall survival rate was 87% (34/39) and the kidney was salvaged in 67% (26) patients at a median follow-up of 18 months. Altered mental status, thrombocytopenia, renal failure and severe hyponatremia at presentation were significantly associated with mortality rate. There was no significant difference in final outcome based on radiological classification. Extensive renal parenchymal destruction of >50% (based on computed tomography) significantly predicted the need for nephrectomy (P < 0.001) and death (P = 0.02). Early (<1 week) nephrectomy resulted in a higher mortality rate (three of seven patients) than initial conservative management. There were no deaths in selected patients who received antibiotics alone or had delayed nephrectomy (four patients each). Of 24 patients who had minimally invasive treatment alone, two (8%) died. Minimally invasive treatment resulted in high renal salvage (22/24, 92%). Altered mental status, thrombocytopenia, renal failure and severe hyponatremia at presentation are associated with higher mortality rates, whereas extensive renal parenchymal destruction is associated with a need for nephrectomy. Early nephrectomy is associated with higher mortality rates than is initial conservative management.

Xanthogranulomatous pyelonephritis in children: diagnostic and therapeutic aspects.

Xanthogranulomatous pyelonephritis (XGP) is a rare, chronic inflammatory disease of the kidneys. It is characterized by destruction of renal parenchyma and accumulation of lipid-laden foamy macrophages. Diffuse and focal forms are known. The condition is mainly observed in middle-aged women, and it is very rare in childhood. Of 32 nephrectomies carried out in children for various diseases in our hospital over the course of 2 years, there were two cases of diffuse XGP. In both cases, the preoperative diagnosis based on ultrasound findings was highly suggestive of XGP. We present the two cases and define the typical ultrasonographic signs for distinguishing XGP from other renal masses. The diagnostic and therapeutic management is discussed and an overview of the literature is given.

Bilateral Xanthogranulomatous Pyelonephritis

Xanthogranulomatous pyelonephritis is an uncommon form of chronic bacterial pyelonephritis characterized by the destruction of renal parenchyma and the presence of granulomas, abscesses, and collections of lipid-laden macrophages (foam cells) replacing the renal parenchyma. This case report illustrates the clinical course of bilateral diffuse xanthogranulomatous pyelonephritis with a subtle manifestation in contrast to those typically presenting with fever, flank pain or urinary tract infection. The patient therefore received supportive treatment for 18 months without hemodialysis, instead of the curative treatment, bilateral nephrectomy, which would have caused immediate loss of residual renal function and dependence on hemodialysis.

Renal parenchymal malacoplakia: a different stage of xanthogranulomatous pyelonephritis?

Malacoplakia is a rare inflammatory condition characterized by demonstrative Michaelis-Gutmann bodies, which are foamy histiocytes with distinctive basophilic inclusions. Malacoplakia is caused by the inadequate elimination of bacteria by macrophages or monocytes as a result of defective phagocytic activity. Xanthogranulomatous pyelonephritis is characterized by the destruction of renal parenchyma and its replacement by solid sheets of foamy lipid-laden macrophages. Prolonged infection of the kidney, which is frequently caused by an obstruction of the urinary tract, is the pathologic mechanism of that condition. We present a 6-year-old patient with a poorly functioning kidney who had a prolonged recurrent urinary tract infection. The results of histologic analysis revealed an inflammatory infiltration consisting predominantly of foamy and epithelioid histiocytes that contained round intracytoplasmic concretions characteristic of Michaelis-Gutmann bodies. We suggest that malacoplakia might be a stage of xanthogranulomatous pyelonephritis.