Diagnosis Of Xanthogranulomatous Pyelonephritis Research Articles

Xanthogranulomatous pyelonephritis presenting as a cystic mass: a rare case report

Xanthogranulomatous pyelonephritis may, rarely, occur as a renal cystic mass. We report a case report of a 50-year-old with a history of medically treated renal lithiasis, who consults for left low back pain. Imaging findings concluded to a Bosniak type-3 hemorrhagic cystic mass of the left kidney. The diagnosis of xanthogranumolatous pyelonephritis on its focal form was made histologically. The diagnosis of xanthogranulomatous pyelonephritis is often difficult even with surgical findings and frequently a histological surprise. This points out the importance of identifying it in pre-operative staging; the diagnosis may be suggested by the association of chronic pyelonephritis, renal stones and hypovascular renal tumor syndrome without specificity at sonography and CT.

Usefulness of ultrasonography, computed tomography and magnetic resonance in the diagnosis of xanthogranulomatous pyelonephritis

Usefulness of ultrasonography, computed tomography and magnetic resonance in the diagnosis of xanthogranulomatous pyelonephritis

DIFFICULTIES IN THE DIAGNOSIS AND SURGICAL TREATMENT OF XANTOGRANULOMATOUS PYELONEPHRITIS

Purpose: The diagnosis of xanthogranulomatous pyelonephritis is primarily histological. The mandatory studies that have to be performed are: abdominal echography, excretory urography, CT, and renal angiography. Methods: The current report covers a period of 16 years (1992-2008) and presents clinical material from 9 patients with a long history of nephrolithiasis. In the past, six of them have undergone surgical or extracorporeal lithotripsy. Results and conclusion: The performed preoperative imaging studies showed kidney tumors, and the operative treatment method used was nephrectomy. The post-operative follow-up did not detect any complications in any of these patients

Xanthogranulomatous pyelonephritis: The conundrum of a calcified kidney

Abstract Xanthogranulomatous pyelonephritis (XGP) is an uncommon chronic destructive granulomatous inflammation of the kidney that can sometimes mimic other renal pathologies like tumours or infections. For this reason, it is also called “the great imitator”. This is the case of a 7-year old girl that presented to the hospital with right hip pain and a suspicious right sided abdominal lesion, thought initially to be a Wilms’ tumour and then an appendiceal mass with a psoas abscess. The abscess was percutaneously drained and the patient was treated with intravenous antibiotics. At 6 weeks interval, the interval appendicectomy was negative. On subsequent follow-up imaging, an abnormally structured kidney was shown, surrounded by a calcified rim and a remnant psoas abscess, which suggested XGP or tuberculous (TB) pyelonephritis as differentials. A DMSA scan showed no function in the affected kidney and the patient underwent a nephroureterectomy. The histopathology showed features that prompted consideration of tuberculosis but ultimately allowed a diagnosis of XGP. XGP can be a confounding pathology as in the present case, where there remained multiple clinical, radiological and histological differentials throughout the course of the patients care, right up to the final diagnosis.

WITHDRAWN: Well surgical outcome of malakoplakia and xanthogranulomatous pyelonephritis which presented in the same patient: A case report and literature review

Abstract Xanthogranulomatous pyelonephritis (XGP) and malakoplakia (MKP) are chronic inflammatory condition of kidney characterized by infiltration of inflammatory cells. We describe the case of a 82 year-old female with a diagnosis of XGP under ureteroscopy with biopsy, who underwent radical nephrectomy and final pathology report was malakoplakia. Both diseases may combine but it's rare. With this case we hope to bring further evidence to support that these two diseases are not mutually exclusive but they can present on the same patient.

A rare case of xanthogranulomatous pyelonephritis in a child with a doubling of the upper urinary tract (clinical case)

Xanthogranuomatous pyelonephritis (CP) is an aggressive form of interstitial nephritis, including purulentdestructive and proliferative processes in the kidney to form granulomatous tissue. The difficulty of diagnosis of CP, low illumination of this problem in the literature are the reason for the publication of even a single observation. The exact diagnosis of the disease can be established only with morphological examination and, as a rule, after surgical treatment. The clinical observation of the treatment of the child 15 years xanthogranulomatous pyelonephritis, inpatient Nizhny Novgorod regional children's teaching hospital. A boy M. at the age of 15 years entered the clinic of acute pyelonephritis (fever up to 38–39°С, abdominal pain and left side). From anamnesis it is known that at the age of one year the child was diagnosed with recurrent leukocyturia. Urological examination revealed hydronephrosis of the lower half of the double kidney on the left. At the age of 7 he was operated on (due to negative dynamics), reconstructive surgery was performed – prilohanochnaya pyeloplasty on the lower segment of the double kidney on the left. In the subsequent exacerbations of pyelonephritis was not. 6 years after hepatitis and kidney injury (contusion), there was a significant increase in dilation of the abdominal system of the lower segment of the left kidney with exacerbation of secondary pyelonephritis. According to intravenous urography, MSCT, MRI (performed to exclude Wilms tumor), the absence of the function of the lower segment of the kidney with a sharp increase in its size was determined. After the preoperative examination, the left kidney was examined, in which the signs of xanthogranulomatous pyelonephritis (renal tissue of bright yellow color), lower left heminephroureterectomy were found, the Diagnosis was confirmed by morphological examination. In the postoperative period, a cyst of the lower pole of the kidney was formed, cured by percutaneous drainage, sclerosing under ultrasound control, followed by recovery. Thus, this clinical case demonstrates the complexity of the diagnosis of CP, which often occurs under the mask of a variety of diseases, including acute pyelonephritis and kidney tumors. Reliable diagnosis of xanthogranulomatous pyelonephritis is possible only with the help of histological examination of pathological tissues.

A Case of Xanthogranulomatous Pyelonephritis Associated with Renoduodenal Fistula

Xanthogranulomatous pyelonephritis (XGP) is a rare form of pyelonephritis associated with repeated infection, chronic inflammation, and obstruction. Various fistulas, including those to the intestine, are a known association with XGP. Here, a 55-year-old woman with a history of multiple previous renal calculi presented with dysuria and back pain. Contrast-enhanced computed tomography (CT) revealed a soft tissue density in her renal pelvis and perirenal space consistent with XGP along with a tract connecting the upper pole of her right kidney to the second portion of the duodenum. This finding was subsequently confirmed during percutaneous nephrostomy placement, stent placement, a small bowel follow-through study, and upper endoscopy. She was diagnosed with XGP with associated renoduodenal fistula, eventually treated by open nephrectomy with fistula takedown. Histopathologic analysis was consistent with the diagnosis of XGP with no malignant or infectious cause of the fistula. XGP should be considered in the diagnosis of patients with dysuria and back pain, especially when a history of obstruction or chronic inflammation. Associated fistulas should also be considered prior to surgical management to prevent complications.

Acute Kidney Injury and Hepatic Dysfunction

This clinical report presents a 45-year-old female patient with acute kidney injury, hepatic dysfunction and urosepsis without past history of any illness related to urinary system. Laboratory investigations showed Hb 15.6 gm/dl, neutrophilic leukocytosis, thrombocytes 9000/mm3, ESR 90 mm/h, plasma thromboplastin time (PTT) 48 seconds (control 32 seconds), INR 2, and fibrinogen degradation product 7500 ng/ml (normal <250 ng/ml). Serum creatinine was 450 μmol/L (5.1 mg/dl), direct bilirubin 68.40 μmol/L, alanine aminotransferase 1.6 mmol/L and albumin 25 gm/L. Urinalysis revealed leucocyturia, hematuria without casts and proteinuria. Abdominal plain x-ray revealed left-sided radio-opaque shadow at the ureteric line, left uretero-hydronephrosis with thickened cortex and left ureteric stone, but normal right kidney. Computerized tomography of abdomen showed a large left kidney (13.5 cm) with totally distorted architecture, multiple enhancing and non-enhancing sectors, thickening of renal capsule, moderate dilatation of renal pelvis, dilated ureter and no passage of contrast in the ureter. The patient was treated with a 2-week course of Ceftriaxone and Aztreonam and preoperative session of hemodialysis before the performance of a left-sided nephrectomy. Gross examination revealed adherent capsule, granular cortex covered with purulent exudates, no demarcation between cortico-medullary junction, and the cut surface showed minute abscess and necrosis with markedly dilated pelvis. Light microscopic examination showed fibrosis and inflammation of parenchyma with vacuolized histiocytes foam cells surrounding necrotic areas confirming the diagnosis of xanthogranulomatous pyelonephritis. The patient was discharged after 35 days of hospital stay with normal renal and hepatic function.

Xanthogranulomatous pyelonephritis

Two cases of Xanthogranulomatous pyelonephritis are presented. One 8 years old boy with history of previous trauma followed by infection and the other a lady of 45 years with a history of repeated urinary tract infection and both presenting with lumbar mass. Nephrectomy was performed in both cases and histological examination revealed a diagnosis of Xanthogranulomatous pyelonephritis.

Laparoscopic nephrectomy for xanthogranulomatous pyelonephritis – Are there predictive factors for success?

OBJECTIVES:Laparoscopic nephrectomy for xanthogranulomatous pyelonephritis is currently associated with great operative difficulty and surgical complications. Herein, we report on our single-center experience and describe predictive factors for successfully accomplishing this procedure.METHOD:Between March 1998 and April 2010, 66 patients (27 men and 39 women) underwent laparoscopic nephrectomy for the treatment of a unilateral nonfunctioning kidney. These patients had previous diagnoses of renal chronic inflammation associated with calculi and previous pyonephrosis. All of the nephrectomies were performed using the transperitoneal approach, and a similar technique was used for radical nephrectomy.RESULTS:Laparoscopic nephrectomy for the treatment of renal chronic inflammation was successful in 58/66 cases (87.9%). Eight cases were converted to the open technique because of difficulty in progression, which was related to the discovery of dense adhesions in the hilar or perirenal region. One major (colonic lesion) and two minor (wound infection) complications occurred in the conversion group. A diagnosis of xanthogranulomatous pyelonephritis was confirmed pathologically for all of the specimens. Of the factors examined, a longitudinal renal length greater than 12 cm (laparoscopy group - 7.2±1.8 cm, versus open group - 13.6±1.5 cm; p<0.05) and time to access the renal vessels (laparoscopy group - 32±18 min, versus open group - 91±11 min; p<0.05) were associated with a higher conversion rate. Although the number of patients in the conversion group was small, the majority of these patients received right-sided nephrectomy.CONCLUSIONS:Laparoscopic nephrectomy for the treatment of xanthogranulomatous pyelonephritis is feasible and associated with low levels of morbidity. Factors including the time required to control the renal vessels, renal length and right-sided nephrectomy were associated with higher chances of conversion into an open procedure.

Xanthogranulomatous pyelonephritis: A rare entity

Context:Xanthogranulomatous pyelonephritis is an extremely rare but known entity resulting from prolonged suppuration of the kidney. The disease may be focal or diffuse and may pose considerable diagnostic dilemma at times. Surgery is curable and remains optimal treatment of choice. Owing to its rarity and clinical curiosity we report such a rare case encountered in our clinical practice.Case Report:We report a case of non-functioning kidney suggestive of either Tuberculosis or xanthogranulomatous pyelonephritis in the pre-operative period depending upon the clinical aqumen and investigations available and nephrectomy was done. It was confirmed as xanthogranulomatous pyelonephritis histopathologically.Conclusion:Preoperative diagnosis of xanthogranulomatous pyelonephritis may pose difficulty and nephrectomy remains the treatment of choice especially in diffuse cases of xanthogranulomatous pyelonephritis.

Xanthogranulomatous Pyelonephritis in a male child with renal vein thrombus extending into the inferior vena cava: a Case Report

BackgroundWe present a case of Xanthogranulomatous pyelonephritis (XGPN) in a male child with renal vein thrombus extending into the inferior vena cava. This is a rare presentation. XGPN is a rare type of renal infection characterised by granulomatous inflammation with giant cells and foamy histiocytes. The peak incidence is in the sixth to seventh decade with a female predominance. XGPN is rare in children.Case presentationAn 11 year old male child presented with a history of high grade fever and chills, right flank pain and progressive pyuria for two months. He had a history of vesical calculus for which he was operated four years back. In our case, a subcapsular right nephrectomy was performed. The surgical specimens were formalin fixed and paraffin embedded. The sections were stained with routine Hematoxylin & Eosin stain. Grossly; the kidney was enlarged with adherent capsule and thickening of the perinephric tissue. The pelvicalyceal system was dilated and was filled with a cast of pus. Histological evaluation revealed diffuse necrosis of the renal parenchyma and perinephric fat. Neutrophils, plasma cells, sheets of foamy macrophages and occasional multinucleate giant cells were seen. The renal vein was partially occluded by an inflammatory thrombus with fibrin, platelets and mixed inflammatory cells. The thrombus was focally adherent to the vein wall with organization.ConclusionsThe clinical presentation and the macroscopic aspect, together with the histological pattern, the cytological characteristics addressed the diagnosis towards XGPN with a vena caval thrombus. Our case illustrates that the diagnosis of XGPN should be considered even in paediatric age group when renal vein and vena caval thrombi are present.

Diagnostic Difficulties in Diffuse Xanthogranulomatous Pyelonephritis: A Case Report and Review of the Literature

Xanthogranulomatous pyelonephritis is a rare, severe, and chronic infection of the kidney characterized by the replacement of renal parenchyma by the xanthoma cells which is difficult to diagnose radiologically. We report a 40-year-old male who had vague abdominal mass and fever for more than 2 months. Weight loss and fatigue were the associated symptoms. Ultrasonography revealed a grossly enlarged right kidney with replacement of renal parenchyma by multiple hypoechoic areas with perinephric thickening and a large staghorn calculus. An abdominal computed tomogram demonstrated an irregular, enlarged right kidney with multiple low-density round areas and calculi. Diminished excretion of contrast media and a severe perinephric inflammatory reaction were present. A presurgical diagnosis of xanthogranulomatous pyelonephritis was made. First, drainage of the extrarenal abscess under proper antibiotic coverage was done and later, a two stage nephrectomy was done considering the debilitating condition of the patient.

Xanthogranulomatous pyelonephritis in pediatric patients: Case report and review of literature

Xanthogranulomatous pyelonephritis (XPN) is an unusual and rare form of chronic renal suppuration. XPN is often mistaken for renal malignancy; hence nephrectomy is commonly performed and the diagnosis confirmed by histopathology. Recent advances in imaging have allowed the radiological features to be characterized, such that routine nephrectomy is avoided. Approximately 240 cases of XPN have been reported in children. We report a 17-year-old female who presented with a 2-month history of increasing abdominal pain and intermittent episodes of increased frequency and dysuria. Plain antero-posterior radiograph of the abdomen revealed a left staghorn calculus. Computed tomography scan with intravenous contrast revealed a low-density inflammatory area and reduced cortical dye uptake on the left renal parenchyma as compared to the opposite side. A dimercapto-succinic acid renal scan revealed that the affected kidney contributed 18% of differential function. A diagnosis of XPN was made. The patient underwent percutaneous nephrostomy tube placement in an attempt to salvage the kidney. The patient eventually failed conservative management. Our review of the literature suggests that medical management has worked in some focal XPN cases, but has not been sufficiently tested in diffuse XPN.

An unusual case of xanthogranulomatous pyelonephritis in a leukemia patient

We report a 65-year-old woman with leukemia who presented with urinary tract infection, splenic abscess, and a renal mass. Both urine and pus culture of the splenic abscess yielded Klebsiella pneumoniae. The differential diagnosis of the renal mass by radiological findings included unliquefied renal abscess, xanthogranulomatous pyelonephritis, and renal cell carcinoma. Percutaneous biopsy of the renal mass confirmed the diagnosis of xanthogranulomatous pyelonephritis. Because of high surgical risk, the patient received medical treatment with prolonged antibiotic therapy. With antibiotic therapy only, not only the splenic abscess was cured but also follow-up ultrasonography showed progressive resolution of the renal mass. The occurrence of xanthogranulomatous pyelonephritis has rarely been reported in the absence of urinary tract obstruction or nephrolithiasis. Furthermore, this is the first report of xanthogranulomatous pyelonephritis occurring in patients with leukemia and concurrent with splenic abscess. In addition to describing this unusual case, we provide a short review of xanthogranulomatous pyelonephritis successfully treated with antibiotics only.

Xanthogranulomatous pyelonephritis complicated by emphysematous pyelonephritis in a hemodialysis patient

Xanthogranulomatous pyelonephritis and emphysematous pyelonephritis are two uncommon variants of pyelonephritis. The combined occurrence is very rare and has not been described in dialysis patients. We report a 78-year-old woman with end-stage renal disease receiving chronic hemodialysis who presented with a one-week history of vague abdominal pain. During the previous 4 months, she had experienced four episodes of urinary tract infection presenting with fever and pyuria which were improved by antibiotic therapy. The urine cultures yielded Klebsiella pneumoniae at all events. Abdominal computed tomography showed the right kidney replaced by multiple hypodense masses. A kidney biopsy demonstrated characteristic pictures of xanthogranulomatous pyelonephritis. Subsequent computed tomography showed gas bubbles formation in the right renal masses suggestive of emphysematous pyelonephritis. Because the patient refused surgical nephrectomy, percutaneous needle aspiration with prolonged antibiotic treatment was done. Follow-up computed tomography demonstrated dramatic regression of the renal mass. This case suggests that xanthogranulomatous pyelonephritis can be complicated by emphysematous pyelonephritis. Furthermore, the unique features in end-stage renal disease patients make the diagnosis of xanthogranulomatous pyelonephritis more difficult.

Laparoscopic Nephrectomy for Xanthogranulomatous Pyelonephritis in the Absence of Kidney Stones or Clinical Urinary Infection

Here, we present a patient who underwent transperitoneal laparoscopic nephrectomy for a nonfunctional kidney on the left side, and who was found to have xanthogranulomatous pyelonephritis (XGP) on the subsequent histopathology examination. XGP is a severe, chronic infection of the renal parenchyma. Nephrectomy is the treatment of choice. Preoperative diagnosis of XGP can be challenging because the clinical presentation may vary. Our patient's loss of kidney function was due to a simple cortical kidney cyst that compressed the urinary collecting system. He presented only with mild flank pain and a poorly functioning kidney, and therefore XGP was not suspected before surgery. Because of the renal and perirenal inflammatory changes that commonly accompany XGP, the laparoscopic approach is difficult and is therefore rarely used. However, laparoscopic nephrectomy for XGP offers an easier recovery for the patient and therefore deserves further consideration as a method of treatment.

Xanthogranulomatous pyelonephritis complicated by psoas abscess

Xanthogranulomatous pyelonephritis is an unusual variant of chronic pyelonephritis. Xanthogranulomatous pyelonephritis is associated with urinary calculi, urinary tract obstruction, and invasion of the renal parenchyma. Pathologically, xanthogranulomatous pyelonephritis consists of a yellow (xantho) colored infiltrate in renal tissue with granulomatous formation. Xanthogranulomatous pyelonephritis may be distinguished from chronic pyelonephritis by renal size. Typically, the kidneys are enlarged in xanthogranulomatous pyelonephritis and are small/shrunken with chronic pyelonephritis. The diagnosis of xanthogranulomatous pyelonephritis is made by abdominal computed tomography scanning showing the characteristic “bear paw” sign, or findings typical for xanthogranulomatous pyelonephritis, eg, multiple hypo dense areas with ring-enhancing lesions. The definitive treatment for xanthogranulomatous pyelonephritis is antimicrobial therapy and nephrectomy. We present a case of xanthogranulomatous pyelonephritis complicated by psoas abscess.

Xanthogranulomatous pyelonephritis in childhood: differential diagnosis to nephroblastoma by sonography

Xanthogranulomatous pyelonephritis (XGP) in children, often presenting with an abdominal tumor, hematuria, and weightloss, necessitates the exclusion of nephroblastoma (Wilms' tumor) with certainty for adequate therapy. To date, the use of CT-scans has widely been recommended; therefore, the feasibility of establishing the diagnosis of XGP by ultrasound and Doppler-sonography alone was evaluated in a series of four children. All children admitted due to abdominal tumors, hematuria, and weightloss were examined by ultrasound and/or Doppler-sonography. Out of 54 children operated on due to renal tumors between 1989 and 1996, all four patients with diffuse XGP were diagnosed by ultrasound alone, in two cases despite contrary diagnoses in CT-scans. The characteristic sonographic features of XGP were recorded and compared to CT-scans and published data. The typical sonographic findings were: enlargement of the kidney and absence of normal parenchyma; replacement of tissue by multiple cysts filled with echogenic material; mostly multiple concrements and/or a large central calculus (staghorn calculus); and absence of blood vessels/signals of blood flow by Doppler-sonography within the cysts. The diagnosis of XGP was in all cases confirmed histologically, no cases of XGP were missed pre-operatively by sonography. The incidence of XGP is higher than currently anticipated. The diagnosis of xanthogranulomatous pyelonephritis can pre-operatively be established in many cases by ultrasound and Doppler-sonography alone with sufficient certainty, if the specific criteria are worked out, thus allowing a reduction of exposure to X-rays in children. Therefore, CT-scans should be reserved for cases where the diagnosis cannot be established by sonography.

Angiographic Features of Xanthogranulomatous Pyelonephritis

Preoperative diagnosis of xanthogranulomatous pyelonephritis (XGP) is possible in numerous cases by renal angiography, thus permitting the differentiation of this disease from renal adenocarcinoma. Angiographic features are reviewed in patients with proved XGP. The most useful findings are: (1) presence of hypervascularised areas; (2) dilated renal capsular and perforating arteries, and (3) heterogenous aspect of the kidney during the nephrographic period.