Xanthogranulomatous Pyelonephritis Research Articles

Incidentally Detected Primary Squamous Cell Carcinoma of Kidney Arising from Renal Pelvis Impersonating Xanthogranulomatous Pyelonephritis

Incidentally Detected Primary Squamous Cell Carcinoma of Kidney Arising from Renal Pelvis Impersonating Xanthogranulomatous Pyelonephritis

Septic shock secondary to xanthogranulomatous pyelonephritis: A case report and literature review

Introduction: Xanthogranulomatous pyelonephritis is described by histopathology as a destruction of the renal parenchyma and replaced by a chronic infiltrate of lipid-laden macrophages. It is known that patients with xanthogranulomatous pyelonephritis have a high rate of perioperative and postoperative morbimortality; however, there are few case reports on this entity. Case Report: A 35-year-old woman attended the emergency department due to the presence of pain in the left flank, accompanied by an altered state of consciousness and respiratory distress. The study protocol started, identifying a significant increase in the left kidney, the presence of a central staghorn stone, dilated minor calices, and clinically with septic shock. The clinical conditions improved by adding intravenous fluids, vasoactive amines, red blood cells concentrates, and broad-spectrum antibiotics. Subsequently, a left nephrectomy was performed. On the following days, the septic shock gradually resolved, leading to the patient’s discharge. Eventually, histopathology report was reviewed, confirming a xanthogranulomatous pyelonephritis. Conclusion: When a xanthogranulomatous pyelonephritis clinical suspicion is found, it is considered a surgical emergency. Furthermore, if proper management is not given immediately, there is a high risk of complications and death. However, the current statistics in Mexico have not been updated to contrast these data.

Role of Imaging in Renal Infections: A Narrative Review

Urinary tract infections (UTIs) are among the most common bacterial infections in community and hospital settings. Infections of the urinary system can range from pyelonephritis to urethritis. Acute renal infections encompass entities such as acute pyelonephritis, acute focal bacterial nephritis, renal and perinephric abscesses, emphysematous pyelonephritis, and pyonephrosis, while xanthogranulomatous pyelonephritis is a chronic granulomatous inflammatory condition that affects the kidneys.The diagnosis of UTIs predominantly relies on clinical assessment and confirmation through abnormal laboratory results. Routine medical imaging is therefore typically reserved for complicated cases, aiming to identify contributing factors such as renal calculi, determine the type of infection, and evaluate the extent of the infection and its associated complications. Furthermore, imaging has become crucial for radiologists during interventional procedures in treating pyonephrosis and renal abscesses. Traditional imaging tools, like abdominal X-rays, are vital for identifying renal calculi and gas shadows in emphysematous pyelonephritis, while ultrasonography emerges as an excellent modality for assessing urinary infections in emergency scenarios, pregnancy, and paediatric cases. Contrast-enhanced computed tomography (CECT) or non-contrast computed tomography (NCCT) is the imaging method of choice in the most complex situations, allowing for precise assessment of the disease burden. Current magnetic resonance imaging (MRI) sequences yield promising results in specific scenarios such as pregnancy and paediatric subjects where minimising radiation exposure is a concern. This review focuses on elucidating the essential radiological modalities and their distinctive features in the context of renal infections, offering valuable guidance to microbiologists and physicians.

Safety and Diagnostic Efficacy of Image-Guided Biopsy of Small Renal Masses.

Image-guided renal mass biopsy is gaining increased diagnostic acceptance, but there are limited data concerning the safety and diagnostic yield of biopsy for small renal masses (≤4 cm). This study evaluated the safety, diagnostic yield, and management after image-guided percutaneous biopsy for small renal masses. A retrospective IRB-approved study was conducted on patients who underwent renal mass biopsy for histopathologic diagnosis at a single center from 2015 to 2021. Patients with a prior history of malignancy or a renal mass >4 cm were excluded. Descriptive statistics were used to summarize patient demographics, tumor size, the imaging modality used for biopsy, procedure details, complications, pathological diagnosis, and post-biopsy management. A biopsy was considered successful when the specimen was sufficient for diagnosis without need for a repeat biopsy. Complications were graded according to the SIR classification of adverse events. A chi-squared test (significance level set at p ≤ 0.05) was used to compare the success rate of biopsies in different lesion size groups. A total of 167 patients met the inclusion criteria. The median age was 65 years (range: 26-87) and 51% were male. The median renal mass size was 2.6 cm (range: one-four). Ultrasound was solely employed in 60% of procedures, CT in 33%, a combination of US/CT in 6%, and MRI in one case. With on-site cytopathology, the median number of specimens obtained per procedure was four (range: one-nine). The overall complication rate was 5%. Grade A complications were seen in 4% (n = 7), consisting of perinephric hematoma (n = 6) and retroperitoneal hematoma (n = 1). There was one grade B complication (0.5%; pain) and one grade D complication (0.5%; pyelonephritis). There was no patient mortality within 30 days post-biopsy. Biopsy was successful in 88% of cases. A sub-group analysis showed a success rate of 85% in tumors <3 cm and 93% in tumors ≥3 cm (p = 0.01). Pathological diagnoses included renal cell carcinoma (65%), oncocytoma (18%), clear cell papillary renal cell tumors (9%), angiomyolipoma (4%), xanthogranulomatous pyelonephritis (1%), lymphoma (1%), high-grade papillary urothelial carcinoma (1%), and metanephric adenoma (1%), revealing benign diagnosis in 30% of cases. The most common treatment was surgery (40%), followed by percutaneous cryoablation (22%). In total, 37% of patients were managed conservatively, and one patient received chemotherapy. This study demonstrates the safety and diagnostic efficacy of image-guided biopsy of small renal masses. The diagnostic yield was significantly higher for masses 3-4 cm in size compared to those <3 cm. The biopsy results showed a high percentage of benign diagnoses and informed treatment decisions in most patients.

Xanthogranulomatous pyelonephritis presenting as giant hydronephrosis in young women: a very rare case report

BackgroundXanthogranulomatous pyelonephritis (XGP) is common in middle-age female, involved kidney usually is hydronephrotic, non-functioning and associated with stones but giant hydronephrotic presentation is a very rare.Case presentationWe report a case of 25-year-old female presented as huge cystic abdominal lump involving left hemi-abdomen and crossing midline associated with pain. On radiological evaluation, she had giant left non-functioning hydronephrotic kidney pushing small and large bowel on right side for which she underwent open simple nephrectomy. To our surprise, her histopathology report was Xanthogranulomatous pyelonephritis. Only one case reported till date of Xanthogranulomatous pyelonephritis presented as giant hydronephrosis in adult.ConclusionXanthogranulomatous pyelonephritis is very rare cause of giant hydronephrosis with a varying clinical and radiological presentation and difficult to diagnose preoperatively.Diagnosis of XGP should be entertained in case long-standing gross hydronephrotic obstructed, infected kidney with stone disease.

Xanthogranulomatous Pyelonephritis: Case Report

BackgroundIn the emergency department (ED), pyelonephritis is a fairly common diagnosis, especially in patients with unilateral flank pain. Xanthogranulomatous pyelonephritis (XGP) is a rare type of pyelonephritis that is associated with unique features, which may lead to its diagnosis. Case ReportA 30-year-old male patient presented to the ED for evaluation of right-sided abdominal pain that has been ongoing for the past 24 hours. He noted the pain was located predominantly in the right flank and described it as sharp in nature. The pain was nonradiating and was associated with scant hematuria. He stated that he had similar pains approximately 1 month earlier that resolved after a few days. The patient underwent a bedside ultrasound and a subsequent computed tomography (CT) scan of the abdomen and pelvis, which showed an enlarged, multiloculated right kidney with dilated calyces and a large staghorn calculus, findings that represent XGP. Why Should an Emergency Physician Be Aware of This?This case report highlights an unusual variant of pyelonephritis, a relatively common ED diagnosis. XGP should be considered in patients with recurrent pyelonephritis, as treatment for XGP may require surgical intervention in addition to traditional antibiotic management.

A Peculiar Cause of Shock: Analysing Two Clinical Cases

Introduction. Pheochromocytoma is a rare neoplasia arising from the adrenal medulla that secretes catecholamines. Those afflicted by this condition can present a wide range of symptoms. One of the most common is paroxysmic hypertension. Interestingly, although rare, some patients present with shock. We describe two cases of pheochromocytoma in which the initial presentation was shock. Case 1. 49 year-old woman, with a history of resistant hypertension, presented to the emergency department with thoracic pain and fever. EKG, echocardiogram (ECC), and myocardial necrosis markers were compatible with Takotsubo syndrome (TS). CT demonstrated a staghorn calculus, hydronephrosis, and signs compatible with xanthogranulomatous pyelonephritis in the right kidney. Additionally, and incidentally, it revealed a 60 mm nodule on the right adrenal gland. Piperacillin/tazobactam was started immediately, and the patient was submitted to urgent upper urinary tract drainage. This procedure was complicated by a cardiorespiratory arrest that was treated with adrenaline administration. The patient was admitted to the ICU due to multifactorial shock and started alpha and, posteriorly, beta blockage. Biochemical adrenal incidentaloma endocrinologic study was negative (under hemodialysis). Multiorgan failure progressively improved. After 2 weeks, the patient was submitted to a laparoscopic transperitoneal right adrenalectomy. No complications were reported. Histological analysis revealed a pheochromocytoma. Case 2. 28-year-old woman presented to the emergency department with headaches and nausea. Vitals were compatible with shock. CT revealed an incidental 72 mm mass on the right adrenal. EKG, ECC, and myocardial necrosis markers were compatible with TS. The patient was started on alpha and, posteriorly, beta blockage. Adrenal incidentaloma endocrinological study demonstrated high urinary catecholamines. Right transperitoneal adrenalectomy was performed. No complications were noted. Histological analysis revealed a pheochromocytoma. Conclusion. Pheochromocytoma can present with complex, enigmatic, and rare clinical pictures. Clinicians should be wary of the possibility of this diagnosis when managing adrenal masses.

Tumefactive Nonneoplastic Proliferative Pseudotumors of the Kidneys and Urinary Tract: CT and MRI Findings with Histopathologic Correlation.

A diverse spectrum of pathologically distinct, nonneoplastic, proliferative conditions of the kidneys and urinary tract demonstrate a expansile growth pattern similar to that of neoplasms. The renal pseudotumors include myriad causes of infections as well as rare noninfectious causes such as sarcoidosis, amyloidosis, and immunoglobulin G4-related disease (IgG4-RD). Rare entities such as cystitis cystica, endometriosis, nephrogenic adenoma, and pseudosarcomatous myofibroblastic proliferation and distinct types of prostatitis comprise tumefactive nontumorous disorders that affect specific segments of the urinary tract. The pseudotumors of the kidneys and urinary tract demonstrate characteristic histopathologic and epidemiologic features, as well as protean clinical manifestations, natural history, and imaging findings. Many patients present with genitourinary tract-specific symptoms or systemic disease. Some cases may be incidentally discovered at imaging. Some entities such as perinephric myxoid pseudotumors, IgG4-RD, fibroepithelial polyp, and nephrogenic adenoma display specific anatomic localization and disease distribution. Imaging features of multisystem disorders such as tuberculosis, sarcoidosis, and IgG4-RD provide supportive evidence that may allow precise diagnosis. Fungal pyelonephritis, xanthogranulomatous pyelonephritis, IgG4-RD, actinomycosis, and endometriosis show markedly low signal intensity on T2-weighted MR images. Although some pseudotumors exhibit characteristic imaging findings that permit correct diagnosis, laboratory correlation and histopathologic confirmation are required for definitive characterization in most cases. A high index of suspicion is a prerequisite for diagnosis. Accurate diagnosis is critical for instituting optimal management while preventing use of inappropriate therapies or interventions. Surveillance CT and MRI are frequently used for monitoring the response of pseudotumors to therapy. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.

Clinical treatment experience of xanthogranulomatous pyelonephritis in both native kidneys 20 years after kidney transplantation

Clinical treatment experience of xanthogranulomatous pyelonephritis in both native kidneys 20 years after kidney transplantation

Xanthogranulomatous Pyelonephritis as a Complication of Obstructive Uropathy: Clinical Case

Xanthogranulomatous Pyelonephritis as a Complication of Obstructive Uropathy: Clinical Case

Kronik Piyelonefritin Nadir Bir Nedeni: Ksantogranulomatöz Piyelonefrit

Xanthogranulomatous pyelonephritis (XGP) is a chronic, destructive, granulomatous inflammation of the renal parenchyma leading non-functioning kidney. Contrast-enhanced computed tomography is the most useful diagnostic method. A 6-year-old female patient admitted to us with complaints of abdominal pain, fever, fatigue, weakness. Recurrent urinary tract infection was present in her history. The patient’s urine specimen revealed leukocyturia, hematuria, positive for nitrite and bacteria, white blood cell: 12.7x103 /microl, hemoglobin:6.2 g/dl and CRP: 101 mg/dl. In the urinary system USG imaging, the contours of the left kidney were irregular and lobulated, and medullary punctate echogenicity and calcifications were present. Contrast-enhanced abdominal computed tomography showed increased left kidney size and opacities suggestive of stone in the collecting system; pararenal area was heterogeneous. Although the patient's gentamicin treatment was completed in 7 days and meropenem treatment in 14 days, acute phase reactants did not regress. No activity uptake was observed in the left kidney lodge in renal cortical scintigraphy. Left total nephrectomy was performed with the diagnosis of non-functioning left kidney and chronic pyelonephritis. Kidney biopsy material were reported as XGP. XGP is a rare and aggressive cause of chronic pyelonephritis with serious consequences such as nephrectomy requirement.

Preoperative risk factors in patients with xanthogranulomatous pyelonephritis undergoing nephrectomy

Preoperative risk factors in patients with xanthogranulomatous pyelonephritis undergoing nephrectomy

DUBIOUS APPENDICITIS TO BE ACCOMPANIED BY RIGHT XANTHOGRANULOMATOUS PYELONEPHRITIS: A CASE REPORT

Xanthogranulomatous pyelonephritis (XGP) is a rare chronic kidney infection that can cause a progressive decline in kidney function and lead to kidney removal or death. Symptoms of right flank pain due to XGP, sometimes radiating to the lower abdomen were difficult to assess and distinguish from urinary tract diseases alone or accompanied by the involvement of other organs like appendicitis. We report a fifty-year-old woman was referred because of a suspected mass in the right kidney based on ultrasound, but the results of the Ct-Scan with contrast showed stones and chronic parenchymal kidney with a tendency to right pyelonephritis. There were no post-contrast enhancing masses in both kidneys. Then, decided to perform a nephroureterectomy and found inflammation in her appendices. Histopathology showed xanthogranulomatous pyelonephritis and chronic appendicitis. The patient was diagnosed with Chronic pyelonephritis based on CT-Scan, but the previous ultrasound showed no appendicitis, there was a mass in the right kidney. During nephroureterectomy, there were chronic appendicitis and Xanthogranulomatous Pyelonephritis after histopathology examination. This report describes uncommon pyelonephritis and confirms the difficulty of differentiating right XGP from appendicitis, even though it occurred in a large city. Moreover, it can be a lesson for general practitioners to be more thorough in diagnosing right abdominal or flank pain.

Pielonefritis xantogranulomatosa: un reto actual para la laparoscopia.

To present the results of our case series on laparoscopic nephrectomy in xanthogranulomatous pyelonephritis (XGP). A retrospective study was conducted that included 143 patients treated with laparoscopic nephrectomy for non-functioning kidney, of whom 15 had XGP, within the time frame of 2011 to 2019. The demographic and clinical data were collected, along with the intraoperative results, complications, and days of hospital stay. Transperitoneal laparoscopic nephrectomy was successfully performed on 15 patients with XGP, with no need for conversion. Mean intraoperative time was 124.4 minutes (range 70-240) and intraoperative blood loss was 148.5 ml (range 30-550), with no blood transfusion required. No intraoperative complications occurred but there was one postoperative complication (6.6%), classified as Clavien-Dindo I (surgical wound infection). Mean hospital stay was 2.85 days (range 2-7). Nephrectomy is the definitive management for XGP, and the laparoscopic approach should be considered a treatment modality, despite the fact that the pathology involves a severe chronic inflammatory process. Its benefits are reduced surgery duration, less blood loss, a lower complication rate, and fewer days of hospital stay, when performed by a skilled and experienced surgeon.

Des nodules cutanés de la paroi abdominale révélant une pyelonéphrite xanthogranulomateuse

IntroductionXanthogranulomatous pyelonephritis is a chronic pyelonephritis characterized by an inflammatory granulomatous reaction that destroys the renal parenchyma. It is an uncommon entity. Diffuse inflammation has the potential to spread to nearby organs, especially the skin. ObservationA 73-year-old patient presented with a three-year history of painful and fistulized nodules on the abdominal wall. The results of abdominal computed tomography and magnetic resonance imaging revealed xanthogranulomatous pyelonephritis with extension to the skin, colon, and psoas muscle. The skin lesions were improved by a double antibiotic therapy. The patient was advised to have a radical left nephrectomy, but he refused surgery and was then lost to follow-up. ConclusionWe report an uncommon case of xanthogranulomatous pyelonephritis revealed by cutaneous nodules of the abdominal wall, with an extension toward the skin, the colon and the psoas muscle.

#6056 NEPHROLOGIC INVOLVEMENT IN A SURGICAL COMPLICATION: WHEN TO SUSPECT A PYELO-DUODENAL FISTULA

Abstract Background and Aims Spontaneous pyeloduodenal fistula is a rare condition occurring primarily after urologic events, in most cases infected kidney stones, pyonephrosis, xanthogranulomatous pyelonephritis, renal tumors, and infected renal cysts, with nowadays 80 cases described. The close relationship between the kidney and the duodenum is a facilitating condition. Method We describe the case of a 78 yo woman admitted in April 2022 for Acute Kidney Injury associated with fever, vomiting, oliguria and metabolic alkalosis. Over the last two years the patient reported recurrent febrile episodes associated with abdominal tenderness and weight loss. Urine cultures showed recurrent bacterial growth and she received antibiotics for recurrent episodes of pyelonephritis and lower urinary tract infections (K. Pneumonie ESBL +, E. Faecalis, P. Mirabilis). She was under nephrologic follow-up with a renal function demonstrating eGFR CKD-EPI of 35-30 ml/min/1.73 m2. In past medical history she reported atrial fibrillation in DOAC, heart failure with preserved ejection fraction, hypertension, previous left occipito-parietal ischemic stroke and right parotid adenoma. On physical examination of the abdomen there was no tenderness, mild pain in the right hypochondrium, Giordano's maneuver mild positive on the right side. Because of the evidence of lithiasis in the right kidney on ultrasound with grade III hydroureteronephrosis, we performed a CT scan with contrast, finding imaging compatible with right pyelonephritis with associated grade IV hydronephrosis, in particular lithiasic formation localized at the level of the right pyelo-ureteral junction (2 × 1cm), with partial involvement of the proximal portion of the ureter, severe calico-pyelic dilatation with overall reduction of the cortico-medullary thickness; diffuse inhomogeneity of the middle and lower thirds of the renal parenchyma, with evidence of some bubbles in contextual areas and inhomogeneity of the perirenal adipose tissue. Reduced nephrographic effect in the post-contrastographic phases and lack of elimination of the contrast in the urographic phase (12 min) were reported. She was started on antibiotics piperacillin-tazobactam and underwent right percutaneous nephrostomy placement. During the procedure we evidenced a communication between the calyx of the right upper calyceal group and an intestinal loop, probably the duodenum (Fig. 1). Results The patient underwent elective laparotomic surgery for right nephrectomy (Fig. 2) and closure of the intestinal fistula with duodenoraffia and omental patch. She was admitted to a post-operative intensive care unit, given comorbidities and the complexity of the operation. She was discharged in 9 days without post-operative complications, with stable renal function. One month after discharge the patient died of pneumonia. Conclusion Pyeloduodenal fistula is an infrequent condition causing occasional or continuous passing of materials between the alimentary canal and urinary tract. The presence of gastrointestinal symptoms and urinary tract alterations may be misinterpreted when occurring. Management of this case required collaboration between several specialists, with particular skills on AKI and CKD, infective complications, interventional radiology and surgical procedures. The outcome was strongly affected by the patient's general condition and comorbidities, with a good short-term outcome but complications on the long-term follow-up. The occurrence of air in the urinary tract is strongly suggestive of communications across the renal pelvis and the gastrointestinal tract. In particular if occurring in the setting of recurrent infections and nephrolithiasis, the diagnosis of pyelo-intestinal fistula should be considered.

Clinical case. Focal form of xanthogranulomatous pyelonephritis, complicated by spontaneous renal rupture

Clinical case. Focal form of xanthogranulomatous pyelonephritis, complicated by spontaneous renal rupture

Metastatic xanthogranulomatous pyelonephritis managed with immunosuppression.

A male aged in his mid-60s was diagnosed with xanthogranulomatous pyelonephritis after a left nephrectomy for a renal mass that was detected during the investigation of weight loss and drenching night sweats. Past medical history includes type 2 diabetes mellitus, transient ischaemic attack, hypertension, non-alcoholic fatty liver disease, dyslipidaemia, osteoarthritis and active smoking. Three years after the initial diagnosis, the patient represented with abdominal pain. CT imaging demonstrated new pulmonary and pancreatic lesions, which were histologically confirmed to be xanthogranulomatous disease. The patient was too unstable for surgical intervention so was commenced on glucocorticoids with marked improvement in his clinical condition with resolution of inflammatory markers and radiographic improvement. Weaning of prednisolone led to a relapse of disease, which was managed with re-introduction of high-dose prednisolone and the initiation of azathioprine. The patient is now 2 years post initiation of immunosuppressive therapy with stable renal function and no active inflammation.

Clinical Presentation, Microbiological Characteristics, and Their Implications for Perioperative Outcomes in Xanthogranulomatous Pyelonephritis: Perspectives from a Real-World Multicenter Practice.

Xanthogranulomatous pyelonephritis (XGP) is an uncommon chronic granulomatous infection of renal parenchyma. XGP is often associated with long-term urinary tract obstruction due to stones and infection. We aimed to analyze the clinical, laboratory, and microbial culture profiles from bladder and kidney urine of patients who were diagnosed with XGP. Databases of patients with histopathological diagnosis of XGP from 10 centers across 5 countries were retrospectively reviewed between 2018 and 2022. Patients with incomplete medical records were excluded. A total of 365 patients were included. There were 228 (62.5%) women. The mean age was 45 ± 14.4 years. The most common comorbidity was chronic kidney disease (71%). Multiple stones were present in 34.5% of cases. Bladder urine culture results were positive in 53.2% of cases. Kidney urine culture was positive in 81.9% of patients. Sepsis and septic shock were present in 13.4% and 6.6% of patients, respectively. Three deaths were reported. Escherichia coli was the most common isolated pathogen in both urine (28.4%) and kidney cultures (42.4%), followed by Proteus mirabilis in bladder urine cultures (6.3%) and Klebsiella pneumoniae (7.6%) in kidney cultures. Extended-spectrum beta-lactamases producing bacteria were reported in 6% of the bladder urine cultures. On multivariable analysis, urosepsis, recurrent urinary tract infections, increased creatinine, and disease extension to perirenal and pararenal space were independent factors associated with positive bladder urine cultures. On multivariable analysis, only the presence of anemia was significantly more frequent in patients with positive kidney cultures. Our results can help urologists counsel XGP patients undergoing nephrectomy.

Vanishing Kidney: On the Far End of the Spectrum of Xanthogranulomatous Pyelonephritis.

Xanthogranulomatous pyelonephritis (XGP) is a rare and severe form of chronic pyelonephritis associated with the destruction of the renal parenchyma and granulomatous inflammation with foamy lipid-laden macrophages resulting from urinary tract obstruction, nephrolithiasis, infection, diabetes, and immune compromise. Kidney parenchyma could be detected easily in XGP even if it is atrophic. However, here we present a 58-year-old man with XGP in which the renal parenchyma has near completely disappeared, which we referred to as the "vanishing kidney."