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PubMed1994

Xanthogranulomatous pyelonephritis with multiple cutaneous fistulae.

Xanthogranulomatous pyelonephritis is characterized by a xanthogranulomatous inflammatory response by the kidney to bacterial infection. The actual histologic diagnosis of this condition is usually made by the pathologist following nephrectomy. Cutaneous fistulae and internal sinus formation, albeit rare, have been reported to occur. Herein we report a case of xanthogranulomatous pyelonephritis in which multiple internal and cutaneous sinuses first developed two months following nephrectomy.

Journal Article↗

PubMed1991

Fine-needle aspiration cytology of xanthogranulomatous pyelonephritis.

Fine-needle aspiration cytology of xanthogranulomatous pyelonephritis in a fifty-seven-year-old Japanese woman is reported. Foamy cells and cells showing a gland-like pattern originating from degenerative renal tubules were found in the aspirated smears. Multinucleated giant cells and cells with pale yellowish cytoplasm were seen in the imprint smears at operation. These findings were diagnostic for xanthogranulomatous pyelonephritis. The cytologic diagnostic differences among xanthogranulomatous pyelonephritis, well-differentiated renal cell carcinoma, and renal oncocytoma are also described.

Biopsy, Needle↗

PubMed1977

Diffuse xanthogranulomatous pyelonephritis in children: an unrecognized variant.

Xanthogranulomatous pyelonephritis in childhood has been thought to exist only in focal form. We encountered 2 cases of diffuse xanthogranulomatous pyelonephritis in children and have found 3 others reported in the literature, making it necessary to change this concept. The essential radiologic and pathologic differences between focal and diffuse xanthogranulomatous pyelonephritis are reviewed.

Child, Preschool↗

PubMed2004

Ultrasonographic features of focal xanthogranulomatous pyelonephritis.

OBJECTIVE: To analyze the ultrasonographic features of focal xanthogranulomatous pyelonephritis. METHODS: Ultrasonographic features of 15 patients with pathologically proved focal xanthogranulomatous pyelonephritis were retrospectively analyzed by 2 radiologists who reached a consensus, in terms of the location, margin, size, and echo texture of the mass, associated calculi, lymphadenopathy, or local extension, in comparison with computed tomographic and clinical findings. RESULTS: At ultrasonography, 12 (80%) of 15 masses were well circumscribed. The maximal sizes of the masses ranged from 2.5 to 5.8 (mean, 3.8) cm. Thirteen solid masses (87%) were hyperechoic (n = 7), hypoechoic (n = 4), or isoechoic (n = 4) to the renal cortex, and the preoperative diagnosis was either renal cell carcinoma (n = 11) or Wilms tumor (n = 2). The preoperative diagnosis of the other 2 cystic lesions (13%) was renal abscess. Renal calculi were found in 1 case, but lymphadenopathy or local extension was not depicted. Clinical inflammatory signs were found in 11 of 15 patients. CONCLUSIONS: There were no specific ultrasonographic features that allow for the distinction between focal xanthogranulomatous pyelonephritis and renal tumors or abscesses. Focal xanthogranulomatous pyelonephritis should be considered when there are clinical signs of infection or inflammation and a focal solid mass is seen on ultrasonography.

Abscess↗

PubMedDate not supplied

[Xanthogranulomatous pyelonephritis: clinical, radiological and pathologic characteristics].

OBJECTIVES: Xanthogranulomatous pyelonephritis is an atypical chronic infection which simulates a malignant renal neoplasia, definitive diagnosis of which is obtained by pathologic study after surgical removal. In this paper we analyze our experience and compare it to that reported on the literature. METHODS: We performed a retrospective study of cases of xanthogranulomatous pyelonephritis diagnosed in the period from January 1945 to December 2000 at the Institute of Neoplastic Diseases, analyzing clinical, radiological, and surgical features documented in the medical records. RESULTS: There were 11 cases, 82% of them were females. The presence of signs and symptoms such as pain and abdominal mass appeared in 73%, accompanied by hematuria and fever. Most radiological tests showed destruction of the renal parenchyma with abnormalities in the collecting system and obstruction by lithiasis. 91% of the cases had positive urine cultures, being Escherichia coli, Proteus Mirabilis and Klebsiella the most frequent germs. Simple nephrectomy was the surgical treatment, and complications were minimal. CONCLUSIONS: Xanthogranulomatous pyelonephritis should be considered in the differential diagnosis of renal cancer because of its clinical features.

Adult↗

PubMed1993

Successful management of bilateral xanthogranulomatous pyelonephritis by bilateral partial nephrectomy.

Bilateral xanthogranulomatous pyelonephritis is a rare condition with 7 previously reported cases, all of which required dialysis and/or resulted in death of the patient. We report a case in which bilateral partial nephrectomy was performed successfully for bilateral xanthogranulomatous pyelonephritis. The etiology, symptomatology, radiographic findings and treatment of this rare inflammatory condition are discussed with a brief review of the previously reported cases.

Aged↗

PubMed2002

[Magnetic resonance tomography of xanthogranulomatous pyelonephritis. Epidemiology, pathogenesis and symptoms].

Xanthogranulomatous pyelonephritis (XGP) is a rare chronic infection of the kidney. In this overview article we reevaluated the magnetic resonance imaging (MRI) findings of our four patients with histologically proven XGP and correlated them with the CT and ultrasound findings described in the literature. Additionally, we give an overview of the pathogenesis and epidemiology. The following criteria were found in MRI: hydronephrosis and/or urethral stricture, vesicoureteral reflux or neurogenic bladder depletion disorders, and calculus as the origin of urinary obstruction. Moreover, in contrast to normal pyelonephritis, XGP is accompanied by fatty deposits in the peripelvic parenchyma, which demonstrate contrast enhancement and form the typical so-called bear paw sign. As XGP is often accompanied by severe kidney failure, contrast-enhanced CT with nephrotoxic contrast agents should be avoided and MRI should be performed instead. Because of proven reduced nephrotoxicity of gadolinium chelates, MRI seems to be superior to CT in patients with suspected XGP. Essential for the correct diagnosis is consideration of the complete medical history including recurrent pyelonephritis to avoid malpractice.

Adolescent↗

PubMed2006

Renal tuberculosis simulating xanthogranulomatous pyelonephritis with contagious hepatic involvement.

Xanthogranulomatous pyelonephritis (XGPN) is a chronic renal infection typically associated with nephrolithiasis and a non-functioning kidney. Renal tuberculosis is a major cause of morbidity in developing countries. Despite recent advances in diagnosis, it is sometimes difficult to differentiate renal tuberculosis preoperatively from XGPN. We present herewith a case report of a patient who was preoperatively diagnosed with a right non-functioning kidney due to renal calculus with stage 3 XGPN and adjacent liver abscess on computed tomography. Subsequent histopathological examination of the nephrectomised specimen revealed renal tuberculosis. To our knowledge this is the first case of renal tuberculosis spreading to the liver and causing liver abscess formation which was misdiagnosed as XGPN preoperatively.

Adult↗

PubMed2006

Focal xanthogranulomatous pyelonephritis -- a diagnostic dilemma.

Focal Xanthogranulomatous Pyelonephritis (XGPN) may be erroneously interpreted as renal cell carcinoma. We report a case of a young Philippino who presented with persisting right flank pain for 2 years. Imaging showed a well-delineated lesion in the lower pole of the right kidney extending to the hilum. Nephrectomy was performed under a tentative diagnosis of renal cell carcinoma, whereas histology revealed focal XGPN. Pre-operative diagnosis of focal XGPN was difficult because of radiological similarities to renal cell carcinoma and lack of the usual clinical presentation.

Adult↗

PubMed1992

Xanthogranulomatous pyelonephritis in pelvic ectopic kidney.

Xanthogranulomatous pyelonephritis occurred in a pelvic ectopic kidney in a 70-year-old man. Pre-operative diagnosis was possible due to the typical appearance at CT scan of central lithiasis and multiple rounded areas of low density with enhancing rims (bear paw sign).

Aged↗

PubMedDate not supplied

[Pseudotumoral xanthogranulomatous pyelonephritis. Apropos of a case].

Xanthogranulomatous pyelonephritis may, rarely, occur as a renal tumour syndrome (simulating mainly a renal cell carcinoma). We report one case. The diagnosis is often difficult (even with surgical findings) and frequently a histological surprise. This points out the importance of identifying it in preoperative staging; the diagnosis may be suggested by the association of chronic pyelonephritis, renal stones and hypovascular renal tumour syndrome without specificity at sonography and CT.

Adult↗

PubMed1995

[Xanthogranulomatous pyelonephritis. Apropos of 11 cases].

Xanthogranulomatous pyelonephritis is a rare manifestation of chronic pyelonephritis. 11 cases were treated between 1988 and 1993. Patients age ranged from 17 to 60 years (mean 34 j). A pseudotumoral form was documented in 3 patients and pyonephrosis was found in 8 cases. Urine culture was usually positive for a non specific germ. Imaging technics could differentiate pseudotumoral disease from diffuse disease. Treatment consisted in a nephrectomy.

Adolescent↗

PubMed1997

Xanthogranulomatous pyelonephritis in a renal allograft recipient.

Xanthogranulomatous pyelonephritis rarely occurs in renal allografts. This is the fifth reported case. Diagnosis was made by renal biopsy, which is usually performed to evaluate an elevated serum creatinine. Associated patient symptomology is nonspecific, and graft imaging with ultrasonography and computed tomography was not helpful as it would be with native kidney xanthogranulomatous pyelonephritis. Successful treatment with antibiotics may depend on the serum creatinine at presentation. Prognosis, therefore, is guarded, with a common outcome of irreversible renal dysfunction.

Adult↗

PubMed2000

Focal xanthogranulomatous pyelonephritis with associated bone metaplasia.

Focal xanthogranulomatous pyelonephritis of the left lower pole was accidentally discovered in a 34-year-old woman at sonography. The patient had no history of stones and urinary tract infection and both conventional radiology and CT scan revealed radiated calcifications within a well-circumscribed mass. Surgical treatment consisted of enucleoresection of the lesion, and histopathology revealed a nucleus of bone metaplasia. To the best of our knowledge, metaplastic bone formation has never been documented before with xanthogranulomatous pyelonephritis.

Adult↗

PubMed2001

[Diffuse xanthogranulomatous pyelonephritis: clinical, anatomopathologic, and therapeutic features. Report ot 9 cases and review of the literature].

Diffuse xanthogranulomatous pyelonephritis is a rare chronic pyelonephritis. This study permitted us to notice the various histological, clinical, radiological, and the different means diagnoses of this affection. Retrospectively series of nine patients is reported. The median age was 43 years. The commonest clinical presentation was urinary tract infection, and lumbar pain. Urine culture identified a bacteria in seven cases (77%). Intravenous urography recovers silent kidney (five cases), hydronephrosis (two cases), chronic pyelonephritis (one case) and renal stones in six cases (67%). Treatment consisted of nephrectomy. No specific biological or radiological signs of this affection can be identifying this lesion in preoperative. The diagnosis was revealed by the histological examination of the removed kidney. The outcome is favorable after a follow-up of six months to four years. The clinical features of the pyelonephritis xanthogranulomatous is not specific. Magnetic resonance imaging can give a specificity to this affection. Only histological examination is able to established the definitive diagnosis.

Adolescent↗

PubMed1986

[Xanthogranulomatous pyelonephritis with cancer of the kidney pelvis--a rare coincidence].

Xanthogranulomatous pyelonephritis is a specific form of a chronically destructive inflammation of the kidney. In addition to our own case of the extremely rare coincidence of xanthogranulomatous pyelonephritis and a transitional cell carcinoma of the renal pelvis our report also refers to seven further cases of xanthogranulomatous pyelonephritis. Any preoperative diagnosis usually is inaccurate. The symptoms are: general poor health, renal pain, fever, marked reduction or complete loss of the renal function, and frequently radiological evidence of a renal tumor. Surgery of xanthogranulomatous pyelonephritis often results in nephrectomy.

Adult↗

PubMedDate not supplied

Diffuse xanthogranulomatous pyelonephritis and staghorn calculus: report of one case.

Xanthogranulomatous pyelonephritis and staghorn calculus are rare in children. In this report, we describe a Chinese boy without history of urinary tract infection who developed insidious onset of left flank pain. Urine culture showed Proteus mirabilis infection. Sonography and computed tomography of the abdomen showed typical picture of xanthogranulomatous pyelonephritis and staghorn calculus. Photomicrography showed characteristic lipid-laden macrophage aggregates. After nephrectomy, he was symptom-free. In conclusion, xanthogranulomatous pyelonephritis should be considered in afebrile children with flank pain and staghorn calculus.

Adolescent↗

PubMed1984

Xanthogranulomatous pyelonephritis caused by methicillin-resistant Staphylococcus aureus.

Localized xanthogranulomatous pyelonephritis due to methicillin-resistant Staphylococcus aureus developed in a 41-year-old diabetic patient. She had recurrent bacteremia despite appropriate therapy with vancomycin. Nephrectomy was required for cure and clinical diagnosis. This report emphasizes differences in the clinical presentation and pathogenesis of xanthogranulomatous pyelonephritis caused by S. aureus. Compared with the common form of xanthogranulomatous pyelonephritis caused by gram-negative bacilli, the localized disease due to S. aureus probably results from hematogenous seeding and is not associated with nephrolithiasis or ureteral obstruction. Furthermore, this report indicates that xanthogranulomatous pyelonephritis may be caused by methicillin-resistant S. aureus, a rapidly emerging nosocomial pathogen.

Adult↗