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PubMedDate not supplied

Xanthogranulomatous pyelonephritis with nephrocutanous fistula and coexisting renal replacement lipomatosis: the report of a rare case.

Renal replacement lipomatosis (RRL) is the result of rare, usually unilateral, and severe atrophy and destruction of the renal parenchyma often caused by renal calculi. It may be associated with, sometimes, aging, atrophy, long-standing chronic inflammation and urinary infection, such as renal tuberculosis. We report magnetic resonance (MR) and computed tomography (CT) findings of our case, which has xanthogranulomatous pyelonephritis (XGP) and RRL additionally associated with nephrocutanous fistula.

Adult↗
PubMed1976

[Xanthogranulomatous pyelonephritis].

Based on literature and own case the entity of xanthogranulomatous pyelonephritis is reviewed. In particular are discussed the difficulties of the preoperative diagnostic procedures and the differential diagnosis.

Diagnosis, Differential↗
PubMed2002

[A case of focal xanthogranulomatous pyelonephritis difficult to differentiate from renal cell carcinoma].

A 34-year-old female with left flank pain persisting for 3 months consulted us on 19 Feb, 2001. Ultrasonography (US), computerized tomography (CT), magnetic resonance imaging (MRI) and renal angiography revealed a cystic renal tumor in the upper pole of the left kidney invading the spleen, and paraaortic lymph node swelling. Left radical nephrectomy combined with splenectomy and partial diaphragmectomy was performed under a tentative diagnosis of renal cell carcinoma. However, histopathological findings revealed xanthogranulomatous pyelonephritis (XGP). XGP is a rare, severe, chronic inflammatory disease characterized by accumulation of lipid laden macrophages. XGP is classified as diffuse or focal type. Preoperative diagnosis of focal XGP is difficult because of radiological similarities to renal cell carcinoma. Our case was more difficult to diagnose because she showed few signs of inflammation and had no history of urinary tract infection or stones.

Adult↗
PubMed1989

[Xanthogranulomatous pyelonephritis coexisting with fistula between ureter and sigmoid colon: a case report].

A 63-year-old woman with the complaints of left renal stone and fistula between left ureter and colon was transferred to our clinic by a local doctor. Anemia, gamma-globulinemia, and acceleration of ESR were detected by hematology on admission. Kidney-ureter-bladder X-ray and intravenous pyelography showed left non-functioning kidney with coral stone, and RP revealed a fistula between left ureter and sigmoid colon. She was operated by nephroureterectomy and fistulectomy. The resected kidney appeared pale and parenchyma was almost replaced by yellowish tissue and pus. Histologically, the lesion was confirmed to be xanthogranulomatous pyelonephritis. Meanwhile, the cause of the fistula was considered to be due to extending ureteritis and pelvic infection from the pyelonephritis. Postoperative course was satisfactory.

Female↗
PubMed1989

Renal parenchymal malakoplakia. Histologic spectrum and its relationship to megalocytic interstitial nephritis and xanthogranulomatous pyelonephritis.

We report five cases of renal parenchymal malakoplakia. They represent a histologic spectrum of this uncommon inflammatory process as it involves the renal parenchyma. Only one of these five cases presented the classical histologic picture of malakoplakia ("diagnostic stage"). Two cases--although with similar cellular infiltrate--had a marked paucity of Michaelis-Gutmann bodies and thus might have been classified as megalocytic interstitial nephritis were it not for the identification of such calcific intracellular inclusions under the electron microscope. The fourth case presented a pseudosarcomatous morphology and is similar to what has been described as a late or fibrous stage in malakoplakia of the urinary bladder. The last case had a destructive, frankly granulomatous histologic picture with a preponderance of foamy histiocytes reminiscent of xanthogranulomatous pyelonephritis, but with clusters of von Kossa-positive Michaelis-Gutmann bodies. The last two forms of the disease have not been previously reported to occur in the kidney. We believe that these cases represent various stages of development of the disease.

Adult↗
PubMed1980

Xanthogranulomatous pyelonephritis.

Evaluation of clinical, radiological and pathological data from 10 adult patients with xanthogranulomatous pyelonephritis has been carried out. There are no pathognomonic diagnostic features, but the majority of patients present with a previous history of recurrent urinary tract disorders. Obstruction and infection are essential pathogenetic factors, but it is suggested that immunologic factors are also play a part. The treatment is nephrectomy, as correct diagnosis cannot be established preoperatively, and as the condition is often misinterpreted as renal carcinoma. A definite diagnosis can only be obtained from pathologic examination with demonstration of the characteristic inflammatory xanthogranulomatous reaction.

Adenocarcinoma↗
PubMed1983

Computerized tomography in xanthogranulomatous pyelonephritis.

Computerized tomography offers the means to recognize changes in the kidney associated with xanthogranulomatous pyelonephritis. The preoperative extent of the inflammatory process, reaction of adjacent parenchymal structures, and extension to the muscles and abdominal wall are identifiable on computerized tomography. The presence of obstructing renal stones, thickening of the perirenal fascia and inability of the kidney to handle intravenously injected contrast medium can be assessed with computerized tomography. Low density renal areas measured on computerized tomography may indicate lipid infiltration of the kidney or incorporation of the fat of the renal bed into the tumefactive mass.

Female↗
PubMed1975

New thoughts concerning xanthogranulomatous pyelonephritis (X-P).

A clinical and roentgenographic analysis of 13 patients with pathologically proved xanthogranulomatous pyelonephritis (X-P) has demonstrated that many previously accepted truisms associated with this disease may not be valid. As a result of this study it is suggested that X-P: 1. Does have a prominant female distribution. 2. May arise relatively acutely. 3. Can be associated with a well-functioning kidney. 4. May destroy the kidney and collecting system. 5. Does not demonstrate neovascularity. 6. Can be distinguished angiographically from hypernephroma. 7. May be associated with diabetes. Other important facts were again observed: 1. X-P is still often associated with staghorn calculi and urinary tract obstruction. 2. Proteus mirabilis is the main offending organism.

Adenocarcinoma↗
PubMed1984

[Xanthogranulomatous pyelonephritis in childhood: analysis of 4 cases].

A critical retrospective evaluation of four cases of xanthogranulomatous pyelonephritis (XPG) treated between 1966 and 1980. Incidence was 1.93%. Age range was from 1.5 and 24 months. Interval since first symptoms to diagnosis was between one and 14 months. Clinical presentation was nonspecific in two and urinary symptoms in the rest, abdominal mass present in all, the fourth had an onset similar to an acute leucosis. There were was a grossly dilated pelvis and calices in two patients and nonfunctioning kidney in the others, one with multiple calculi. Ureteral stenosis was present in two and three showed a vesiureteral reflux grade IV. Urinculture yielded E. coli and Proteus mirabilis. In all cases diagnosis was confirmed by macro and microscopic examination. Nephrectomy was effectively cure in all four children. All patients are well at the end of follow-up, between one and four years.

Child, Preschool↗
PubMedDate not supplied

Xanthogranulomatous pyelonephritis: a pathological, clinical and aetiological analysis of 87 cases.

Analysis of 87 cases of xanthogranulomatous pyelonephritis ( XPN ) from 1958 to 1983 (14 males, 73 females, ages 13-85) revealed an incidence of 1.4 cases/100 000 population per annum which is apparently increasing. Clinical, radiological and pathological investigations demonstrated universal urinary obstruction (77.5 per cent calculi, 17.5 per cent pelviureteric junction obstruction) and pathogenic organisms such as E. coli or Proteus were cultured from the urine in 72 per cent of cases. Rare complications included sinuses or fistulae to bowel. We believe that the combination of urinary obstruction and infection by organisms of low virulence initiate XPN , and that associated lipid is derived from renal pelvic adipose tissue. Problems of differential diagnosis are discussed in relation to the use of immunocytochemistry and electron microscopy.

Adolescent↗
PubMed2006

A case of Papillon-Lefevre syndrome associated with xanthogranulomatous pyelonephritis and hepatitis.

Papillon-Lefevre syndrome (PLS) is an autosomally recessive palmoplantar keratoderma accompanied by psoriasiform plaques on the extensor surfaces of extremities and leading to premature loss of deciduous and permanent teeth by progressive periodontitis. Patients with PLS may exhibit mental retardation, intracranial ectopic calcifications, nail dystrophies and a tendency to various infectious disorders, in addition to skin and oral findings. Herein, we report a 26-year-old man with PLS, who had experienced xanthogranulomatous pyelonephritis and hepatitis during childhood and adolescence. To the best of our knowledge, this is the first report of PLS associated with xanthogranulomatous inflammation.

Adult↗
PubMed1981

Xanthogranulomatous pyelonephritis. An immunohistochemical and ultrastructural study on the occurrence of bacteria and bacterial antigen.

Nine kidneys with typical xanthogranulomatous pyelonephritis (XP) involvement were investigated on the occurrence of bacteria, bacterial fragments and antigen, in light microscopy using Gram staining and immunohistochemistry, and by electron microscopy. The present study did not reveal any occurrence of bacteria, bacterial fragments or antigen. It is concluded that the xanthogranulomatous reaction in man represents a resorption phenomenon, and not an immunological reaction to bacteria or bacterial antigen.

Animals↗
PubMed1982

Biliary obstruction due to xanthogranulomatous pyelonephritis.

Presented here is an unusual case of extrinsic biliary obstruction due to a mass caused by xanthogranulomatous pyelonephritis, in itself a rare disease, of the right kidney. This phenomenon has not been described previously in the literature, and it should be brought to the attention of practitioners as another possible cause of biliary disease.

Aged↗
PubMed1982

Diffuse xanthogranulomatous pyelonephritis: analysis by computed tomography and sonography.

The sonographic and computed tomographic findings in 3 cases of diffuse xanthogranulomatous pyelonephritis are presented along with correlation with the pathological specimens. The combination of the findings in sonography and computed tomography in this condition enables one to make an accurate preoperative diagnosis. Calyces containing pus and/or xanthomatous tissue produced low-level echoes simulating preservation or thickening of the renal parenchyma on sonography. On CT the central low attenuation areas either gave negative values representing abundant xanthomatous tissue seen on gross pathology, or measured in the water density range representing a combination of pus and less abundant xanthomatous tissue.

Adult↗
PubMed1982

Xanthogranulomatous pyelonephritis: a reappraisal.

A survey was undertaken of the clinical, radiological, ultrasonic, and pathological features of 80 patients with xanthogranulomatous pyelonephritis (XPN). The condition is a progressive granulomatous reaction to chronic renal inflammation which is often suppurative and usually caused by calculous urinary tract obstruction. The characteristic pathological features are large numbers of foam cells containing lipid, and the presence of inflammatory destruction of neighbouring renal tissue. XPN, which is commoner than generally recognised, may often be diagnosed preoperatively--the patient is usually a middle-aged female who presents with severe toxaemia, tender loin mass, and mild lower urinary tract symptoms. The diagnosis is confirmed by radiology and ultrasonography. Nephrectomy is curative.

Adolescent↗
PubMed1981

[Localized form of xanthogranulomatous pyelonephritis in a child. Case report].

The authors report the case of a 4 1/2-year-old boy with a localized xanthogranulomatous pyelonephritis. Review of the literature shows that this rare condition is often misdiagnosed before surgery, a preoperative diagnosis of Wilms' tumor being proposed instead of the exact one which is of benign prognosis. The pathogenesis is unknown.

Child, Preschool↗
PubMed1984

CT of xanthogranulomatous pyelonephritis: radiologic-pathologic correlation.

A clinical-radiologic-pathologic correlation study was performed in 18 (17 female) patients with xanthogranulomatous pyelonephritis (XGP) with CT scans available for analysis. Presenting signs and symptoms included pain (66%), urinary frequency (66%), dysuria (66%), nocturia (66%), palpable mass (56%), leukocytosis (50%), and fever (50%). The duration of symptoms was usually relatively short (less than 6 months), considering the extent of the pathologic process. In 14 patients, the disease was diffuse; the kidney was enlarged with preservation of the reniform outline in 13. The renal pelvis, lined with sheets of lipid-laden macrophages and surrounded by a marked fibrotic reaction, was contracted in 11 and contained pelvic calculi in 12. The parenchyma was replaced by multiple, rounded, low-density areas on CT that corresponded to dilated calices and/or inflammatory tissue. These areas had enhancing rims (10 cases) that corresponded to preserved, compressed normal parenchyma and/or inflammatory tissue. There was CT identification of unsuspected extension through the renal capsule with involvement of the perirenal space in 11 patients, the pararenal spaces in 13, and the psoas muscle in six. The pararenal space and the psoas muscle were often extensively involved with minimal perirenal disease in six patients, a reflection of chronic indolent infection. There were four cases of focal XGP that appeared on CT as low-density mass lesions with wall enhancement surrounding dilated, stone-filled calices or as focal masses occupying one pole of a duplication. Extensive pararenal disease was present in two of the four cases of focal XGP. The preoperative diagnosis of XGP was suspected in only 44% of cases. It is concluded that CT should play a role in diagnosis and preoperative planning to demonstrate the extent of extrarenal disease that is poorly depicted by other means.

Adolescent↗