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PubMed2000

[Xanthogranulomatous pyelonephritis. Our experience and review of the literature].

BACKGROUND: Ten cases of xanthogranulomatous pyelonephritis (XGP) with diagnostic and therapeutic observation are described and other experiences reported in the literature are analyzed. METHODS: The clinical, laboratory and radiological features of 10 patients who had undergone nephrectomy in our Istitute, between October 1993 and March 2000, with a postoperative pathological diagnosis of XGP have been retrospectively re-evaluated. RESULTS: The most frequent symptom was flank pain. All the patients presented leucocytosis. Urine culture was positive for Proteus Mirabilis in four patients (40%) and for E. Coli in three (30%). In all the patients an ultrasound scan and urography were performed, six patients (60%) had undergone a CT scan and two of them (20%) a MRI. In six patients (60%) urinary lithiasis was associated and it was ramified in four of them (40%). The disease was always unilateral, affecting the right kidney in six cases and the left one in the other four. In three cases (30%) it presented in the focal form. The treatment was always surgical and it consisted of nephrectomy; a conservative surgical approach was used in two cases (20%). At the follow-up 4 patients (40%) showed recurrent urinary tract infections. None presented relapse. CONCLUSIONS: XGP is an uncommon chronic inflammatory disease, often associated with urinary tract infections and/or urolithiasis. The clinical presentation is nonspecific so that differential diagnosis with other kidney diseases becomes difficult. A CT scan can be helpful in formulating diagnosis. The treatment is surgical and it consists of a nephrectomy, while a conservative approach can be reserved in some cases for the focal form. Cases treated with antibotics have been described.

Adult↗
PubMed2003

[Imaging diagnosis of xanthogranulomatous pyelonephritis: report of 6 cases].

OBJECTIVE: To explore the imaging diagnosis of xanthogranulomatous pyelonephritis (XGP), especially the value of angiography. METHODS: Combined with literature review, a retrospective analysis was conducted of the imaging data of 6 pathologically confirmed XGP cases as an attempt to define the preoperative diagnosis of the disease. RESULTS: Four cases of XGP were diagnosed preoperatively, and 2 were misdiagnosed as renal abscess. Renal arteriography revealed more characteristic changes, and the diagnosis of XGP relied on the clinical presentations and multiple imaging examinations. CONCLUSION: Renal arteriography is the principal approach in the diagnosis and differential diagnosis of XGP.

Adult↗
PubMed1990

Xanthogranulomatous pyelonephritis in children and adults--an 8 year study.

20 cases of Xanthogranulomatous Pyelonephritis (XPN) were encountered over an 8 year period, constituting 0.4 percent of the total of 47,370 surgical biopsies, 10 percent of the total of 188 nephrectomy specimens removed for various reasons and 35 percent of the nephrectomy specimens associated with chronic pyelonephritis. This is the largest single series, reported in Indian literature. 16 patients were adults and 4 were children, thus 25 percent of our cases were children, a significantly high proportion. Our youngest patient a 5 1/2 month old male, is to the best of our knowledge, the youngest case reported from India. Males predominated in our series, the M:F ratio being 3:1, this contrasts with western literature in which there is a definite female preponderance. The common presenting symptoms were lumbar pain, fever and palpable non-functioning kidney. 4 cases were complicated by cutaneous sinuses. There was a slight predominance of affectation of the left side over the right side. On gross examination, diffuse lesions were commoner than focal lesions and were seen in children as well. An accurate pre-operative diagnosis was made in only 2 cases, in the rest, the diagnosis was either tuberculosis or pyonephrosis. Thus XPN is quite frequently seen in the adult Indian population and is not as rare in children, as it was once thought to be.

Adolescent↗
PubMed1986

Xanthogranulomatous pyelonephritis in childhood--report of two cases and review of the literature.

Xanthogranulomatous pyelonephritis is a rare disease in children. Two young patients of 9 years and 3 months of age are described, with diffuse XPN in a non-functioning left kidney. Nephrectomy was performed in both cases. XPN is a rare variant of chronic, nonspecific pyelonephritis with either diffuse or local segmental involvement of the kidney. Histologically the renal tissue shows a granulomatous inflammatory infiltrate composed of foam cells, plasma cells, lymphocytes and sometimes multinucleated giant cells, abscesses may be present. An accurate preoperative diagnosis is seldom made; in the presence of a non-functioning kidney treatment is nephrectomy.

Child↗
PubMed1987

Xanthogranulomatous pyelonephritis with emphasis on computerized tomography scan. Retrospective study of 20 cases and literature review.

The authors reviewed 20 cases of xanthogranulomatous pyelonephritis. An accurate preoperative diagnosis of this disease is difficult because of its clinical and radiologic similarities to various other renal lesions. A resistant urinary tract infection in a patient with a nonfunctioning kidney and a perinephric abscess should lead to the condition being suspected. Although xanthogranulomatous pyelonephritis is mainly a histologic diagnosis, computerized tomography opens new perspectives in the preoperative determination. This could allow less radical surgery in selected cases.

Aged↗
PubMed1990

Nucleolar organiser regions in kidney tumours and xanthogranulomatous pyelonephritis.

The AgNOR argyrophil technique was applied to clear cut examples of renal adenoma (n = 7), clear cell carcinoma (n = 9), and xanthogranulomatous pyelonephritis (n = 5). There was no significant difference between mean AgNOR counts per cell in adenomas and carcinomas, supporting the idea that there is a continuous spectrum of kidney tumours. Xanthogranulomatous pyelonephritis and clear cell carcinoma showed significant differences in mean AgNOR counts per cell, suggesting that the technique may be of use in distinguishing between these conditions, although further cases may need to be examined to confirm this.

Adenocarcinoma↗
PubMed1980

Xanthogranulomatous pyelonephritis in childhood.

Two cases of xanthogranulomatous pyelonephritis are reported in Arabs. Reviewing the literature, these cases were similar to previously reported cases. Although there are no pathognomonic clinical features, this disease should be considered in the differential diagnosis of a renal mass.

Child↗
PubMed1977

Xanthogranulomatous pyelonephritis in Malaysians.

Eight cases of xanthogranulomatous pyelonephritis occurring in an oriental population are reported. The patients were mostly middle-aged, and there was a female preponderence. Nephrectomy controlled the disease in all cases. Diagnosis on clinical and radiological grounds is difficult, and it is often only made on pathological examination of the kidney after nephrectomy. The nature of the disease remains obscure.

Adult↗
PubMed1979

The underestimated hazards of xanthogranulomatous pyelonephritis.

Twenty-eight cases of xanthogranulomatous pyelonephritis were studied in retrospect and difficulties in diagnosis and treatment are described. Awareness of the entity is the most effective safeguard against over-aggressive resection for this benign condition.

Adolescent↗
PubMed1985

Xanthogranulomatous pyelonephritis in childhood.

Eleven children with xanthogranulomatous pyelonephritis are reported. The left side was affected in all patients. It is suggested that the diagnosis can be made pre-operatively. The condition is characterised by the fact that it is always unilateral and that renal calculi are found in a kidney with gross impairment of function; associated anaemia, leucocytosis and raised ESR are also present. The cause is unclear, but an obstructive element with infection is usually found.

Child↗
PubMed1978

Xanthogranulomatous pyelonephritis. A report of 2 cases.

Xanthogranulomatous pyelonephritis (XGP) is a rare form of chronic pyelonephritis. The present author has found about 150 cases on going through the literature. The lipid filled "foam cell" is typical of the condition. The preoperative diagnosis is often renal carcinoma. The treatment is nephrectomy. It is important to make the diagnosis in order to avoid unnecessary radical surgery. A unilateral non-functioning kidney with urinary tract infection (with or without calculi) should lead to the condition being suspected. The prognosis is good. Two new cases that both illustrate the condition well are presented.

Adult↗
PubMed1980

Focal xanthogranulomatous pyelonephritis in adulthood.

In adults with xanthogranulomatous pyelonephritis (XGP) focal involvement occurs in 17% Of patients and the remainder have diffuse involvement of the kidney. Most patients are in the fourth and fifth decades. There appears to be a predilection for the left kidney, and 60% of patients will have a positive urine culture. Radiographically, a poorly-functioning, hypovascular renal mass is seen. The clinical and pathological presentations of focal XGP can closely resemble clear-cell renal cell carcinoma, but partial nephrectomy is the preferred treatment for this inflammatory disorder. We discuss three adults with focal XGP who have been treated at The Johns Hopkins Hospital in the past 2 1/2 years.

Adenocarcinoma↗
PubMed1984

Atypical presentation of xanthogranulomatous pyelonephritis: diagnosis by ultrasonography and fine needle aspiration biopsy.

The diagnosis of xanthogranulomatous pyelonephritis may be difficult to make preoperatively. We describe a patient who had a nonfunctioning kidney with a normal collecting system on retrograde pyelography as well as normal angiography and venography. Preoperative diagnosis was xanthogranulomatous pyelonephritis by fine needle aspiration biopsy under ultrasonic guidance.

Adult↗
PubMed2006

Feasibility of laparoscopic approach in management of xanthogranulomatous pyelonephritis.

OBJECTIVES: To report the feasibility of the laparoscopic approach for management of xanthogranulomatous pyelonephritis (XGP). METHODS: From 2002 to 2005, 11 patients underwent laparoscopic (n = 7) or hand-assisted laparoscopic (n = 4) nephrectomy by a single surgeon for pathologically confirmed XGP. The preoperative presentation, operative details, postoperative recovery, and complications were recorded. RESULTS: A total of 5 men and 6 women were included in this study, and the mean patient age was 51 years (range 28 to 78). All cases began with the laparoscopic approach (6 left and 5 right). Four cases were converted to the hand-assisted technique because of the difficulty in progression, but no case required conversion to open nephrectomy. The mean operative time was 157 minutes (range 101 to 201), with a mean estimated blood loss of 217 mL (range 50 to 440). No intraoperative complications occurred. The mean hospital duration was 2.4 days (range 1.5 to 4). Four patients had postoperative complications, including two with an ileus, one with a persistent fever requiring intravenous antibiotics, and one with a renal fossa abscess requiring percutaneous drainage. All specimens were pathologically confirmed to be XGP. CONCLUSIONS: Laparoscopic nephrectomy for XGP is complicated and more technically demanding than the laparoscopic nephrectomy for noninfectious etiologies. Consideration should be made for using a hand port should the laparoscopic procedure fail to progress in a satisfactory manner. In experienced hands, the laparoscopic approach presents a reasonable surgical option for the treatment of XGP. For the novice laparoscopist, however, the open approach should remain the modality of choice.

Adult↗
PubMed1989

Xanthogranulomatous pyelonephritis in a renal allograft: a case report.

We report a case of xanthogranulomatous pyelonephritis in a renal allograft. The kidney was not removed and there was an initial response to antibiotic therapy, with amelioration of toxicity and improvement in renal function. However, the kidney failed 10 months later in association with histological changes of chronic rejection.

Anti-Infective Agents, Urinary↗