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A case of vesico-renal reflux with xanthogranulomatous pyelonephritis complicated with a renocolic fistula in a 20 months old child is reported. Imaging in this case was crucial for the diagnosis and the work up; it included ASP, renal ultrasound, UIV retrograde cystography and CT. The treatment consisted in a right ureteronephrectomy after fistula's section.
Thirty-eight nephrectomy specimens and two biopsies of perinephric abscesses from patients with xanthogranulomatous pyelonephritis have been examined. Twenty showed evidence of venous damage. This included organised thrombi in 12, intimal thickening in five and phlebitis in three. All specimens showed evidence of previous haemorrhage in the form of haemosiderin deposition. These findings differed significantly from a control series of chronic pyelonephritis. It is suggested that venous occlusion and haemorrhage are factors in the pathogenesis of the lipid accumulation in the kidney which is characteristic of this condition. The association of a papillary transitional cell carcinoma of the pelvis in a patient with xanthogranulomatous pyelonephritis is reported for the first time.
A 51-year-old female exhibited fever, left flank pain and left flank mass in March, 1993. Drip infusion pyelography (DIP) revealed a non-functioning left kidney with shadows of calculi, and abdominal computerized tomography (CT) showed renal calculi and multilocular cystic lesions in the left kidney extending through the perinephric space into the mass on the left flank. Percutaneous nephrostomy and percutaneous drainage were performed, followed by left nephrectomy. Histopathological findings revealed xanthogranulomatous pyelonephritis. There have been a few case reports of xanthogranulomatous pyelonephritis forming nephrocutaneous fistula in the back.
A case of focal xanthogranulomatous pyelonephritis (XPN) in a child, successfully cured with antibiotics only, is presented, and this report is followed by a review of the literature on XPN in both children and adults. XPN is a rare inflammatory disease of the kidney. Factors strongly implicated in the development of XPN are genitourinary obstruction and urinary tract infection, although other contributing factors have been suggested. The clinical presentation of the disease is remarkably nonspecific and variable; it therefore is frequently misdiagnosed as other, more common diseases that cause focal or diffuse renal masses, including renal neoplasms, abscesses, and tuberculosis. Diagnosis requires acquisition of renal tissue for special pathological staining. The long-standing mainstay of therapy for XPN has been nephrectomy or partial nephrectomy. However, this report and other recent reports of the successful medical management of focal XPN suggest that a trial of antibiotics prior to surgery is warranted in cases of focal XPN.
We report on a 6-year-old boy with Xanthogranulomatous pyelonephritis. This unusual type of renal inflammation has a typical clinical picture that is important to bear in mind. The affected child is often seriously ill with a palpable flank mass leading to initial suspicion of malignancy. Modern imaging procedures help in obtaining a pre-operative diagnosis.
Fistulization is an uncommon complication in Xanthogranulomatous Pyelonephritis, but harmful for the adjacent organs. Owing to their rare localization we present 6 cases with scrotal skin, bronchi, colon and spleen fistulization.
A retrospective study of 16 Xanthogranulomatous Pyelonephritis (XGP) cases seen during a 12-years period (1983-1994) at the Hospital General de Albacete was performed. An analysis is made of the clinical features, laboratory data and imaging diagnostic techniques, comparing our findings with those of several series published in the literature. The outcome of this study is that clinical and biological picture of XGP is characteristic: Middle-aged woman admitted to a Internal Medicine Service because a constitutional syndrome, with important weight loss, general poor health, acceleration of erythrocyte sedimentation rate (ESR), anemia, hepatic disfunction and renal destruction imagings, frequently with renal stone and urinary tract infection history. This characteristics can be useful to suspect a XGP.
Xanthogranulomatous pyelonephritis (XGP) is a rare and aggressive form of chronic pyelonephritis for which partial or complete nephrectomy is mandatory [1.2]. The diagnosis and, in particular, the differentiation from hypernephroma is mostly established by the histopathological examination only. We have reviewed the literature and present an unusual case of XGP with septic spreading into the lungs mimicking pulmonary metastasis and with an inflammatory infiltration of the descending colon.
OBJECTIVE: We report another case of splenic abscess after nephrectomy, a condition which must be considered in the differential diagnosis of post-operative fever. METHODS/RESULTS: A 20-year-old man presented with lumbar pain and fever. A diagnosis of xanthogranulomatous pyelonephritis was made and he was treated by subcapsular nephrectomy. Thirty days later the patient presented with a lumbar fistula from a splenic abscess and was treated by splenectomy. CONCLUSIONS: Fistulas and abscesses are more common after nephrectomy for xanthogranulomatous pyelonephritis. In our view, the subcapsular approach is an additional risk factor for the foregoing complications.
Xanthogranulomatous pyelonephritis (XGP) is an uncommon renal inflammatory disease characterized by the destruction and replacement of normal parenchyma by sheets of lipid-laden histiocytes. The process may be diffuse or segmental. Sonograms of 16 cases of XGP (13 diffuse, three segmental) were retrospectively reviewed and correlated with their pathologic findings. The typical case of diffuse XGP demonstrates the following: renal enlargement, replacement of normal architecture by multiple fluid-filled masses, pelvic contraction or only moderate separation of the central echo complex, and a pelvic calculus. Although most cases have a large staghorn calculus, its sonographic demonstration may be difficult, perhaps as a consequence of peripelvic fibrosis. Atypical cases of diffuse XGP mimic pyelonephrosis with massive hydronephrosis and fluid--debris levels. In these atypical cases, a staghorn calculus is often conspicuously absent. Segmental XGP is recognized as an area of parenchymal destruction surrounding one calyx or one pole of duplication. Segmental XGP should be distinguished from focal xanthogranulomatous inflammation of the kidney, which is a distinct pathologic entity (cortical location, no pelvic communication, absent pyelitis). When typical gross pathologic features are present, sonography should make possible accurate identification of diffuse and segmental XGP.
A case of xanthogranulomatous pyelonephritis associated with 'small' renal carcinoma is presented. The urinary sediment showed atypical cells, suspect of malignancy. The renal neoplasm measured only 1.5 cm, had the typical papillary configuration of a 'small' renal carcinoma and was composed of atypical cells with finely granular cytoplasm and hyperchromatic nuclei. The xanthogranulomatous pyelonephritis was a primary lesion, spacially separate one from the other. The clinicopathological features of reported examples of coexistence of these diseases have been reviewed.
Fistula or deep sinus formation as a complication of xanthogranulomatous pyelonephritis (XPN) has not been described previously in the British literature. We present the clinicopathological features of one case of a nephrodiaphragmatic sinus complicating XPN, and three cases of nephrocolic fistula, including the first recorded case of fistula in childhood XPN. The detailed clinical, radiological and pathological features of XPN and its complications are reviewed. Total nephrectomy, together with primary excision of sinuses or fistulae, is the treatment of choice.
A case of xanthogranulomatous pyelonephritis (XPN) in a boy of 20 months is reported. The patient suffered from high fever. Leukocytoses, anaemia and enhanced C-reactive protein were detected. Ultrasound and CT showed an enlarged left kidney with atypical structures. Malignancy could not be excluded praeoperatively. The IV pyelogram and scintigraphy revealed a functioning left kidney. Nephrectomy resulted in complete cure. A short description of the XPN and a survey of the literature is given.
Xanthogranulomatous pyelonephritis (X.G.P.) is a rare unilateral manifestation of chronic interstitial nephritis. 4 new cases of X.G.P. in children are reported. The authors review 60 cases of the literature since 1963. The X.G.P. has no predominant sex distribution. The age extended especially between 1 to 5 years. The diffuse type is more common in boys, and the localized type in girls. The clinical signs : fever, abdominal pain, weight loss, urinary infection, abdominal mass. Proteus Mirabilis is the main organism in the diffuse form and Escherichia Coli in the focal form. Actually, the disease is often diagnosed before surgery. The treatment is always nephrectomy and the prognosis is very good (benign). The final diagnosis of X.G.P. can only be made by histological examination. Etiopathogenesis remains obscure : urinary tract infection and obstruction, arterial and veinous lesions, local immunity deficiency.
In a case of diffuse xanthogranulomatous pyelonephritis, computed tomography (CT) and magnetic resonance (MR) were used. The MR proved to be more precise in the preoperative evaluation of inflammatory extension to the spleen and into the abdominal wall. The CT was more accurate in excluding spread to the colon.
A 72-year-old female presented with the complaint of left lower abdominal swelling in May, 2005. Laboratory analysis revealed elevated white blood cell counts and C-reactive protein. Abdominal computed tomography showed left ureteral calculi, left hydronephrosis and a mass extending through the perinephric space, psoas major muscle into the left flank and lower abdomen. Echo-guided needle mass biopsy was performed. Histopathological findings revealed xanthogranulomatous changes. Under the diagnosis of diffuse xanthogranulomatous pyelonephritis extended into psoas muscle and subcutaneous tissue, antibiotic therapy was given for 5 months. After reduction of subcutaneous mass, left nephroureterectomy was performed. Histopathological findings revealed xanthogranulomatous pyelonephritis and ureteritis. Postoperative course was uneventful without any relapse of inflammation.
We report a case of a 74-year-old woman exhibiting the yellow nail syndrome in association with ipsilateral xanthogranulomatous pyelonephritis. Nephrectomy resulted in complete resolution of the pleural effusion and slow improvement of the yellow nails. This report calls attention to the renal-related pleural effusion, and to the thorough investigation needed for the yellow nail syndrome.
Urographic, arteriographic and B-mode echographic findings in a four-year-old girl with tumefactive xanthogranulomatous pyelonephritis are reported. Review of our case and those that preceded it illustrates that when a localized mass in a functioning kidney is encountered radiographically in a child, xanthogranulomatous pyelonephritis should be included in the preoperative differential diagnosis. Nephrectomy may then be avoided.