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The presence of contralateral renal tumour in a case eventually found to have Xanthogranulomatous Pyelonephritis (XP) resulted in a wrong preoperative diagnosis of tumour with bowel fistula. The patient's prior history of bladder tumour and multiple renal cysts is also discussed, along with the retrospective finding of very minor changes in an early angiogram.
The authors present 9 cases of xanthogranulomatous pyelonephritis observed in the "Juan XXIII" Hospital in Tarragona. They emphasize the relationship between lithiasis, chronic urinary infection and antigenic stimulation for the development of this entity, the progressive result of a lesion in the kidney tissue with immobilized infectious calcareous deposits. In the granulomatous lesion they find cells called antigen-antibody quartets, with foamy-type histiocytes, the nodular collections of which constitute the key to X.P. The formation of lymphocytic germinal centres is another antigenic stimulus in some parts of the kidney tissue. These structures are due to the storing of antibodies and therefore the immunoglobulins would not be released towards the blood stream, which would explain changes in the immunoglobulins in these patients' serum.
Haematuria in an elderly patient is a common urological complaint. A patient is described in whom xanthogranulomatous pyelonephritis presented as unilateral renal vein thrombosis. So far as the author is aware, this is the first report of such an association.
In the kidney removed for nephrolithiasis and excretory function failure the authors found lithiasis, xanthogranulomatous pyelonephritis and squamous cell carcinoma. Brief clinical data and results of pathomorphological study are presented.
UNLABELLED: Case report on a boy aged 4. The whole of the right kidney showed changes of xanthogranulomatous pyelonephritis. HISTOLOGY: dense granulomatous infiltrations of xanthome cells, epitheloid and plurinuclear giant-cells, lymphocytes and plasma cells. Diagnostic proof was based on the xanthome cells, large histocells with partially pycnotic nucleus and wide margin of cytoplasm. This condition has, so far, been seen only very rarely in children.
The clinical, pathological and radiographic findings of 135 cases of xanthogranulomatous pyelonephritis have been reviewed. It is a form of renal suppuration and obstruction most commonly seen in middle aged women although all ages and both sexes may be affected. There is no race predilection. Gram-negative organisms are usually present and bilateral involvement has not been reported. The most common offending organism is Proteus mirabilis. Hepatic dysfunction is seen and appears to normalize with removal of the XGP process. Preoperative angiography may increase the accuracy of differentiating this disorder from hypernephroma and may aid the surgeon in planning his approach to kidney resection depending upon the staging of XGP. Chronic renal failure is not usually a feature of XGP and nephrectomy is curative without any incidence of recurrence.
A case is reported of the simultaneous occurrence of renal carcinoma with staghorn calculus, perinephric abscess, and xanthogranulomatous pyelonephritis in the same kidney, with subcutaneous abscess of the thigh as the initial presentation. The coexistence of these diseases in the same kidney would seem to be important since they are frequently confused with each other.
An ultrasound examination performed on a young woman with a long history of urinary tract infection demonstrated multiple subcapsular sonolucencies suggestive of multiple abscesses. The combination of the ultrasonic appearance, the clinical history, and a large nonfunctioning kidney with calculi on intravenous pyelography allowed us to suggest the diagnosis of xanthogranulomatous pyelonephritis. Ultrasound plays an even greater role in patients who are allergic to iodinated contrast material in whom intravenous pyelograms and arteriograms may be contraindicated.
In a woman aged 67, comprehensive angiographic examination revealed an extensive renal process which had led to thrombosis of the inferior vena cava. At exploratory surgery the process seemed inoperable. The angiographic study was repeated after an asymptomatic period of 6 years and disclosed shrinking of the kidney involved. Revision of the microscopic findings altered the initial diagnosis of renal carcinoma in favour of xanthogranulomatous pyelonephritis. The observation is of interest by virtue of the characteristic angiographic findings, extension of the process to the venous system, and angiographic evidence that spontaneous regression is possible.
We report the case of a xanthogranulomatous pyelonephretis in a pelvic ectopic kidney that is revealed by a buttockal abscess.
8 cases of XGP in children are reported. The presence of urolithiasis together with xanthogranulomatous lesion in 7 cases and of nephroblastoma in one may be of help in understanding the aetiopathogenesis. In all the cases the involved kidney did not function thus necessitating subcapsular nephrectomy via retroperitoneal approach.
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