Xanthogranulomatous Pyelonephritis Research Articles

Case report: Xanthogranulomatous pyelonephritis masquerading as cystic renal cell carcinoma

ABSTRACTBackground: Xanthogranulomatous pyelonephritis (XGP) is a rare chronic bacterial inflammation of the renal parenchyma and is often a diagnostic dilemma.Case Presentation: We present a challenging case of a patient with XGP. Initially thought to have had renal cell cancer she was treated accordingly with a partial nephrectomy. However, on the final pathology, she was found to have XGP and required further antibiotic therapy and referral to the infectious disease service.Discussion: Management of XGP and diagnostic pitfalls are discussed.Conclusion: XGP is a diagnostic and therapeutic dilemma. Partial Nephrectomy may be appropriate in management of XGP in select cases.

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 A Review and Update of the Literature

Xanthogranulomatous pyelonephritis (XGP) is a rare chronic destructive granulomatous inflammatory process that affects sporadically the parenchyma of the kidney and the disease tends to be associated in many cases with long-term urinary tract obstruction, urinary tract infection and also in cases with calculi within the kidney. XGP does affect females more commonly in comparison with males, it does affect all age groups including newly born up to the elderly. Majority of the patients tend to be symptomatic and some of the symptoms could include: pyrexia, flank / loin / abdominal pain, palpable mass in loin/abdomen/costovertebral region, weight loss, visible haematuria. There may be associated diabetes mellitus, obesity, or immune deficiency. There may be anaemia and leucocytosis upon blood tests. Urine cultures may grow Escherichia coli, or proteus but in other situations the urine culture could be negative. Ultrasound scan of renal tract, CT and MRI scan of abdomen and pelvis tend to be undertaken in the assessments of patients. CT scan has globally been the establishment of radiology imaging diagnosis. Radiology imaging may demonstrate focal or diffuse XGP but the diffuse form is more common. It may reveal multiple low-attenuated cystic masses in the kidney, calculi in the kidney, hydronephrosis / dilated calyces / bear’s paw appearance in some cases. Macroscopy examination of the specimen of the kidney would tend to show multiple yellow nodules around calyces, and the lesion may form a mass or be infiltrative. Pathology examination of specimens of XGP would tend to show granulomatous inflammatory infiltrate that consists of neutrophils, lymphocytes, plasma cells, xanthomatous histiocytes, as well as multi-nucleated giant cells. Immunohistochemistry staining may show positive staining for CD68. Some of the differential diagnoses include: clear cell carcinoma of the kidney, papillary renal cell carcinoma, sarcomatoid renal cell carcinoma, leiomyosarcoma, malakoplakia of kidney, megalocystic interstitial nephritis, and renal replacement lipomatosis. Majority of diffuse cases have been treated by nephrectomy and antibiotics and some focal cases have been treated by partial nephrectomy and antibiotics but on very rare occasions cases have been treated by drainage of the abscess with biopsy and in conjunction with antibiotics. Percutaneous nephrostomy has also been undertaken pre-operatively to decompress the kidney by draining the abscess in the occasional case.

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.

Xanthogranulomatous Pyelonephritis – Challenges in Management

We present a case of a 50-year-old lady left gluteal collection with communication into the left retroperitoneal plane and continuous with left xanthogranulomatous pyelonephritis. She underwent wound debridement and left nephrectomy. It was subsequently complicated with delayed colonic perforation, recurrent episodes of colocutaneous and nephro-colic fistula. We discuss the complications associated with xanthogranulomatous pyelonephritis and the challenges in managing it.

Complete spontaneous regression of a primary renal cell carcinoma. Report of a pathological proven case and review of the literature

Regression of primary renal cell carcinoma (RCC) is a rare phenomenon and for several reasons many of the reported cases have been questioned. We present a case that can be considered a true spontaneous and complete regression of a primary RCC. A 79-year-old female underwent nephrectomy because a renal tumor. At the time of surgery image studies showed a small para-aortic lymph node. The tumor measured 3cm and was analyzed completely. Histology showed a fibro-inflammatory lesion with necrosis, foamy macrophages and inflammatory cells. No neoplastic cells were observed and the lesion was interpreted as a localized type of xanthogranulomatous pyelonephritis. One year later a CT control scan, showed that the para-aortic lymph node had increased in size to 4cm. Fine needle aspiration revealed features of clear RCC. Metastatic dissemination was limited so surgical removal of the para-aortic lymph node was performed and the cytologic diagnosis confirmed.

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.

Imaging Manifestations of Acute and Chronic Renal Infection That Mimics Malignancy: How to Make the Diagnosis Using Computed Tomography and Magnetic Resonance Imaging

PurposeTo review the computed tomography and magnetic resonance imaging manifestations of acute and chronic renal infections that may mimic malignancy and to provide useful tips to establish an imaging diagnosis. ConclusionAcute and chronic bacterial pyelonephritis are usually readily diagnosed clinically and on imaging when the diagnosis is suspected based upon clinical presentation. When unsuspected, focal, extensive or mass-like, acute and chronic bacterial pyelonephritis may mimic infiltrative tumours such as urothelial cell carcinoma (UCC), lymphoma, and metastatic disease. Infection may be suspected when patients are young and otherwise healthy when there is marked associated perinephric changes and in the absence of metastatic adenopathy or disease elsewhere in the abdomen and pelvis. Renal abscesses, from bacterial or atypical microbial agents, can appear as complex cystic renal masses mimicking cystic renal cell carcinoma. Associated inflammatory changes in and around the kidney and local invasion favour infection. Emphysematous pyelonephritis can mimic necrotic or fistulizing tumour; however, infection is more likely and should always be considered first. Xanthogranulomatous pyelonephritis can mimic malignancy when focal or multifocal and in cases without associated renal calculi. Malacoplakia is an inflammatory process that may mimic malignancy and should be considered in patients with chronic infection. Bacillus Calmette-Guerin (BCG)-induced pyelonephritis is rare but can mimic renal malignancy and should be considered in patients presenting with a renal mass when being treated with BCG for urinary bladder UCC.

Minimally invasive nephrectomy for inflammatory renal disease

ObjectiveOnce chronic inflammatory renal disease (IRD) develops, it creates a severe peri-fibrotic process, which makes it a relative contraindication for minimally invasive surgery (MIS). Our objective is to show that laparoscopic nephrectomy (LN) is a surgical option in IRD with fewer complications and better outcomes. MethodsRetrospective review of patients who underwent a modified-surgical laparoscopic transperitoneal nephrectomy was performed. Data search included all operated patients between May 2013 and May 2018 that had a pathology result with any renal inflammatory condition (xanthogranulomatous pyelonephritis, chronic nephritis, and renal tuberculosis). We describe intra-operative variables such as operative time, blood loss, conversion rate, postoperative complications and length of hospital stay. ResultsThere were 51 patients who underwent laparoscopic nephrectomy with a confirmatory pathology report for IRD. We identified four (8%) major complications; three of them required transfusion and one conversion to open surgery. The mean operative time was 233±108 min. Mean estimated blood loss was 206±242 mL excluding the conversion cases and 281±423 mL including them. The mean length of hospital stay was 3.0±2.0 days. ConclusionLaparoscopic nephrectomy for IRD can safely be done. It is a reproducible technique with low risks and complication rates. Our experience supports that releasing the kidney first and leaving the hilum for the end is a safe approach when vascular structures are embedded into a single block of inflammatory and scar tissue.

Squamous cell carcinoma of the kidney in a patient with staghorn calculi

Primary squamous cell carcinoma of the renal parenchyma is an extremely rare entity. The diagnosis of squamous cell carcinoma of the renal pelvis is usually unsuspected due to the rarity and inconclusive clinical and radiological features. The insidious onset of symptom and lack of any pathognomonic sign leads to delay in the diagnosis and subsequent treatment, resulting in grave prognosis for these patients. Here, we present a case of incidentally detected renal squamous cell carcinoma in a 71-year-old male with a staghorn calculus and Xanthogranulomatous pyelonephritis. The patient was treated with radical nephrectomy.

Xanthogranulomatous pyelonephritis: an analysis of 41 cases

Objective To discuss the clinical diagnosis and treatment of xanthogranulomatous pyelonephritis (XGP). Methods Clinical data of 41 XGP patients admitted from May 1981 to December 2017 were retrospectively analyzed. There were 17 male cases and 24 female cases, aged from 23 to 78 years, with an average age of 57 years. All were unilateral lesions, including 19 cases on the left and 22 cases on the right. Disease duration ranged from 1 week to 12 years, with an average of 3.5 years. The clinical manifestations showed that 7 cases with gross hematuria (17.1%), 16 cases with palpable flank or abdominal mass (39.0%), 36 cases with flank pain (87.8%), 26 cases with acute or intermittent fever (63.4%) and 17 cases with weight loss (41.5%). Laboratory findings showed that 28 cases with leukocytosis (68.3%), 24 cases with anemia (58.5%), 27 cases with pyuria (65.9%), positive urine culture 19/34 (55.9%) , positive urine lipid-laden macrophages 3/14(21.4%) , and 20 cases with rapid erythrocyte sedimentation rate (48.8%). Imaging examination: among 35 patients who received CT examination, 25 were diagnosed as XGP, mainly presenting diffuse changes in the kidney with enlarged renal shadow, accompanied by diffusive distribution of multiple low-density lesions. There was no obvious enhancement in the low-density lesions on enhanced scan, accompanied by thickening of renal fascia, adhesion to psoas major muscle or involvement of surrounding tissues and organs. According to the imaging results, there were 33 cases of diffuse type and 8 cases of localized type in this group. Renal biopsy was performed 11 cases and 3 cases were diagnosed as XGP. Results All patients were treated with surgical procedure. 33 patients with diffuse type were performed nephrectomy. 6 of the 8 patients with localized type underwent partial nephrectomy successfully, and the other 2 patients underwent nephrectomy due to severe renal adhesion and unclear lesion boundaries. All postoperative pathologies suggested xanthogranulomatous pyelonephritis. Patients were followed up for 9 months to 10 years postoperatively, with an average of 4.5 years. All patients had no recurrence. Conclusions The clinical manifestations of XGP are lack of specificity. Diagnosis is difficult and depends on pathology. According to imaging examination, lesions can be divided into diffuse type and localized type. Nephrectomy and partial nephrectomy were performed respectively. Key words: Pyelonepritis, xanthogranulomatous; Diagnosis; Treatment; Surgery

Xanthogranulomatous Pyelonephritis in a Surgically Complicated Patient: A Case Report

Xanthogranulomatous pyelonephritis is an uncommon destructive process that is associated with urinary tract infection and/or obstruction. We present the case of a 63 year old female who had an unusual case of xanthogranulomatous pyelonephritis due to Streptococcus intermedius in the left kidney. CT scan revealed a chronic obstructive pyelonephritis with associated staghorn calculi, and renal histopathology confirmed xanthogranulomatous pyelonephritis with foamy macrophages. She was a surgically complicated patient, who underwent two ventral hernia repairs along with her left nephrectomy. She ultimately had a complete recovery after surgical treatment and antibiotics. J Microbiol Infect Dis 2019; 9(2):90-94.

Surgical treatment of kidney tumor on a patient with second case of staghorn calculus and associated renal hydronephrosis: case report

Staghorn, struvite or coral calculus are the ones that completely or partially occupies the renal pelvis and branches to the renal calices. The presence of renal calculi of any kind in the urinary tracts is related to the appearing of malign tumor in the kidneys, especially in the absence or failed treatment. A male patient, 51 years old, native of Manaus, reports about dysuria and polyuria associated with constant fever episodes and urinary tract infections with improvement by using several antibiotics but returning the symptoms after suspending it. The patient return was in a month and no improvement of the pain in the patient's feeling, with the tomography image tests result showing atrophy in the right kidney, which presents dilatation of the collector system, that it's filled with material with density varying between thick liquid and soft parts (average of 45 UH), in addition to calculus in the pelvis and ureteropelvic junction, suggesting a pattern for xanthogranulomatous pyelonephritis and matching previous history of right staghorn calculus. The association between kidney cancer and staghorn calculus should be consider through the treatment. Patients with renal diseases of severe prognosis in both kidneys must be kept under constant surveillance by the urology and nephrology team, the association of both clinics is essential to a fortunate ending like the case reported.

Effect of Kidney Volume on the Results of Nephrectomy Performed for Xanthogranulomatous Pyelonephritis.

AimThis study aims to evaluate the results of patients we treated with nephrectomy due to Xanthogranulomatous pyelonephritis (XGP) and the effects of kidney volume on the results.Patients and methodsRecords of 22 patients who underwent nephrectomy due to renal masses at our clinic between January 2008 and May 2018 and whose pathology results indicated XGP were retrospectively evaluated. The computed tomography (CT) measurement of the kidney volumes of the patients was calculated as the product of the longest length, width, and height of the kidney. The mean kidney volume of the patients was calculated and the patients were distributed into two groups: those that presented volumes below average (Group 1) and above average (Group 2). The patients’ mean ages, operative duration, hospitalization days, differences in pre- and postoperative hemoglobin and creatinine levels, and postoperative complications were compared across groups.ResultsGroup 1 consisted of 12 patients and Group 2 of 10 patients. The mean kidney volume of the patients was calculated as 33.4 cm3 ± 26.0 cm3. The mean kidney volume of the patients was 15.8 cm3± 9.9 cm3 in Group 1 and 56.8 cm3 ± 21.8 cm3 in Group 2. There were no statistical differences between the two groups in terms of operative times, preop-postop hemoglobin (Hgb) levels and complications.ConclusionIn cases where XGP is considered probable, the priority in preoperative CT must be to thoroughly evaluate the relationship of the kidney with the surrounding tissue and organs rather than to investigate the patients’ kidney volumes.

Clinicopathological Spectrum of Xanthogranulomatous Pyelonephritis.

Xanthogranulomatous pyelonephritis (XGP) is an uncommon and distinct type of chronic infective pyelonephritis causing destruction of the kidney, severely affecting the renal function. The perinephric adipose tissue and peritoneum is not uncommonly involved. The study was undertaken to decipher the clinicopathologic spectrum of XGP. Forty cases of XGP were diagnosed on histopathology over a period of 13 years (2005–2017). Relevant clinical details and radiological findings were recorded from the case files. Out of a total of 40 cases, 26 were female and 14 were male with a mean age of 39.5 ± 13.6 years. Flank pain was the most common presenting symptom. All the patients had unilateral disease and underwent nephrectomy for a nonfunctional kidney. Gross examination showed enlarged kidney with replacement of cortico-medullary tissue by yellow nodular areas of fatty tissue and dilatation of the pelvicalyceal system. Thirty-six (90%) cases had nephrolithiasis. Histologically, the characteristic feature was the existence of lipid-laden foamy macrophages. Renal parenchymal involvement was diffuse in majority (31, 77.5%). Two (5.0%) of the patients had coexisting carcinoma in the same kidney. Histopathologic examination gives the definitive diagnosis of XGP which relies on the characteristic morphology. Surgical intervention in the form of nephrectomy is the treatment of choice and offers good treatment outcomes.

Laparoscopic nephrectomy in xanthogranulomatous pyelonephritis.

IntroductionThe aim of this article was to report our experience with laparoscopic and retroperitoneoscopic nephrectomy in patients with xanthogranulomatous (XPG) pyelonephritis.Material and methodsBetween November 2002 and September 2010, 27 patients, with a mean age of 61.1 years (range 43–85), underwent laparoscopic nephrectomy for a unilateral nonfunctioning kidney, because of xanthogranulomatous pyelonephritis. Patient's data was collected retrospectively and included patient age, gender, intraoperative conversion rate, operative time, estimated blood loss, length of hospital stay, perioperative transfusion rate, renal function pre- and postoperatively and postoperative complications.ResultsLaparoscopic nephrectomy was successful in 26 patients. It was transperitoneal in 15 patients, retroperitoneal in 11 patients and in one patient the operation was initiated as retroperitoneal and converted to transperitoneal. One conversion to open surgery was needed. The mean operative time was 193.6 minutes (range 123–340). The mean estimated blood loss was 223.5 ml (range 30–1000). The mean hospital stay was 4.8 days (range 3–12). The transfusion rate was 29.6%. Serum creatinine was 1.3 mg/dl the day before and the day after the operation. Major complications occurred in patients (11.1%).ConclusionsLaparoscopic nephrectomy should be considered as an initial approach for XGP. The indications for laparoscopic nephrectomy should be extended to these patients.

NEPHRECTOMY. A CLINICOPATHOLOGICAL STUDY

Background: To provide the urologist with the proper histopathological diagnosis of nephrectomy specimens, to correlate the compatibilty of clinical diagnosis and indications of nephrectomy with histopathological results and to see the relative frequency of each type and its specific pathologic characters. The study was conducted at Azadi teaching hospital and in the department of pathology, college of medicine, university of Duhok during a period from (Nov 2012 – Nov 2014). A total 161 nephrectomy specimens were examined grossly. Representative blocks were taken for histopathological examination. 76 patients (47.2%) of the patients were males, (85) 52.8% were females, with male: female ratio of 1:1.08. The mean age was 35.6 years. The histological examinations revealed in descending order 62.65% were inflammatory conditions (including chronic pyelonephritis, xanthogranulomatous pyelonephritis and tuberculous pyelonephritis). Adult type malignant conditions were found in 26% of the total cases (including renal cell carcinoma and transitional cell carcinoma). Only one case was lymphoma and other metastatic carcinoma. 9.8 % were cystic lesions of the kidney, 4.96 % were pediatric tumors (including nephroblastoma only), 2.48% was angiomyolipoma. The study concludes a wide range of renal pathology in this locality, histopathological examination for every nephrectomy specimen is the corner stone for a clinico-morphological correlation and proper management. The chronic pyelonephritis is the most and frequent pathologic indication for nephrectomy irrespective of age or sex. Xanthogranulomatous pyelonephritis is seen in age below 25 years and was usually associated with nephrolithiasis. Renal cell carcinoma is the most common kidney cancer in adults affects mainly males followed by transitional cell carcinoma and Nephroblastoma which is the main type of malignant tumors of the kidney in children. Secondary in the kidney, SCC and lymphoma are rare tumors.

Successful treatment of xanthogranulomatous pyelonephritis in an elderly lady with percutaneous drainage

Successful treatment of xanthogranulomatous pyelonephritis in an elderly lady with percutaneous drainage