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PubMed1976

Ultrastructure of experimental xanthogranulomatous pyelonephritis.

The ultrastructure of xanthogranulomas developing during obstructive suppurative pyelonephritis was studied in rats with a permanent ligature of one ureter and an intravenous injection of E. coli suspension. The xanthogranulomas consisted of macrophages with numberous phagolysosomes containing rests of phagocytosed polymorphonuclear leucocytes and bacteria. Lipids identifiable as triglycerides were found in such cells particularly as isolated intracytoplasmic droplets and, less frequently, within the phagolysosomes. The source of isolated intracytoplasmic lipid droplets within the macrophages has remained obscure. Their origin in the macrophages by synthesis could not be excluded, similarly as in the polymorphonuclear leucocytes. PAS positive cells occurring as late as 2 months after the beginning of the experiment at the periphery of xanthogranulomas contained multiple intracytoplasmic vacuoles, most probably phagolysosomes. These cells, with high probability the oldes ones of the macrophagic population in the xanthogranulomas were virtually devoid of lipid droplets.

Animals↗
PubMed1978

[A contribution to radiological diagnostics of xanthogranulomatous pyelonephritis (author's transl)].

Pyelonephritis xanthogranulomatosa is a peculiar manifestation of destructive interstitial nephritis which can be differentiated from other types of pyonephrosis exclusively by microscopic examination. Clinical symptomatology often points towards the existence of a renal tumor. The author analyses the clinical and radiological symptomatology of seven patients treated by him. The angiographic picture presented by pyelonephritis xanthogranulomatosa differs according to the character and extension of the inflammatory tissue lesion. The angiographic picture of the circumscribed and diffuse granular proliferative types resembles that of a poorly vascularised malignoma, whereas the destructive type resembles hydropyonephrosis.

Adolescent↗
PubMed1978

Xanthogranulomatous pyelonephritis-presentation as acute renal failure in a child with a solitary kidney.

A 4-year-old girl, who had been in perfect health, presented with the acute onset of renal failure and abdominal mass. Investigations revealed a solitary left kidney which on histology had the typical features of xanthogranulomatous pyelonephritis. The child had no previous history suggestive of chronic renal disease and had no radiologic evidence of renal osteodystrophy. She had no improvement in renal function and has gone on to hemodialysis and transplantation. The unique mode of presentation and the unusual features of this case are discussed.

Acute Kidney Injury↗
PubMed1995

Antigenicities of enteropathogenic Escherichia coli, lysozyme, and alpha-1-antichymotrypsin on macrophages of genitourinary malacoplakia.

Seven cases of genito-urinary malacoplakia were analyzed histologically, ultrastructurally and immunohistochemically in a comparison with two cases of xanthogranulomatous pyelonephritis. Immunohistochemically, von Hansemann cells and Michaelis-Guttmann bodies, both hallmarks for the diagnosis of malacoplakia, showed a common antigenicity for enteropathogenic Escherichia coli as cytoplasmic granules of varying sizes. These microscopic manifestations corresponded ultrastructurally to a series of phagolysosomal degradations of coliform bacilli. Serogroups against E. coli OK antigens, which were positive for malacoplakic cells, were not confined to a particular group. Macrophages of xanthogranulomatous pyelonephritis did not show the E. coli antigenicity. Antigenicity of lysozyme and alpha-1-antichymotrypsin on the von Hansemann cells was equivocal, but these enzymes were strongly positive on macrophages of xanthogranulomatous pyelonephritis. The macrophages of both malacoplakia and xanthogranulomatous pyelonephritis were positive for antihuman macrophage antibody. These results indicate that malacoplakia depends mainly on infection by a non-specific strain of enteropathogenic E. coli and may arise from defective digestive enzyme activity of infiltrating macrophages. Immunohistochemical analysis using antisera against E. coli OK antigens, lysozyme and alpha-1-antichymotrypsin was useful in identifying the prediagnostic stage of malacoplakia and in differentiating the lesion from xanthogranulomatous pyelonephritis.

Adult↗
PubMed1987

Sonography of renal inflammatory disease.

The sonographic findings and differential diagnoses of a wide spectrum of acute and chronic renal inflammatory processes are reviewed. These include focal and diffuse forms of bacterial nephritis, pyonephrosis, intra- and extrarenal abscess, renal tuberculosis and fungal infection, xanthogranulomatous pyelonephritis, and renal parenchymal malakoplakia. The role of ultrasound in the diagnostic and therapeutic management of patients with these diseases is discussed.

Abscess↗
PubMed2004

Elective open nephron-sparing surgery for renal masses: single-center experience with 129 consecutive patients.

OBJECTIVES: To present our experience with elective, open, nephron-sparing surgery for renal masses in a contemporary, consecutive series. METHODS: In this retrospective study, the files of all patients who underwent elective nephron-sparing surgery between January 1996 and December 2002 at our institution were reviewed. The preoperative workup included renal ultrasonography and abdominal computed tomography. The histologic findings, complications, and oncologic outcome were studied. The surgical technique (ischemia and regional hypothermia) was identical in all patients. RESULTS: A total of 129 patients (mean age 61 years) were analyzed. The mean +/- standard deviation tumor size on preoperative computed tomography was 4.0 +/- 2.4 cm. Renal cell carcinoma was present in 86 patients (66.7%), a benign cyst in 18 (13.9%), oncocytoma in 10 (7.8%), angiomyolipoma in 7 (5.5%), adenoma in 4 (3.1%), xanthogranulomatous pyelonephritis in 3 (2.3%), and metastasis of a malignant melanoma in 1 patient. Two patients (1.6%) required secondary nephrectomy because of postoperative bleeding. After a median follow-up of 34 months (range 2 to 91), no patient had developed local recurrence, one (0.8%) had developed lymph node metastasis, and two (1.6%) had developed distant metastases. The creatinine clearance decreased from 77 +/- 27 mL/min before surgery to 64 +/- 23 mL/min after a median of 34 months. CONCLUSIONS: The results of this contemporary, monocenter experience underline the role of open, elective, nephron-sparing surgery for patients with small renal masses, particularly because benign histologic findings were present in almost one third of patients.

Adenoma↗
PubMed2004

Repair of superior mesenteric artery ligation during left nephrectomy with a native renal vein patch.

Injury to the superior mesenteric artery (SMA) during nephrectomy is a rare but potentially catastrophic complication. SMA injury during nephrectomy most commonly occurs with large tumors or bulky lymphadenopathy, with inadvertent injury or mistaken ligation of the SMA instead of the renal artery. Failure to recognize and repair an SMA injury results in ischemic bowel and death for most patients. We report a case of SMA ligation during left nephrectomy for xanthogranulomatous pyelonephritis, review the intraoperative evaluation of suspected SMA injury, and describe our vascular repair using a vein patch from the native left renal vein.

Blood Vessel Prosthesis↗
PubMed2002

Muconephrosis.

We report a case of a mucus-filled kidney (muconephrosis) encountered during laparoscopic nephrectomy for presumed xanthogranulomatous pyelonephritis. Conversion to open nephrectomy and en-bloc right hemicolectomy were necessary because of severe perinephric fibrosis and suspected renal-enteral fistula. Pathologic examination revealed a renal pelvic villous adenoma and diffuse intestinal metaplasia of the urothelium; no enteral communication or gastrointestinal pathologic features were found. Urothelial villous adenoma is extremely rare, and one should consider neoplastic etiologies, including appendiceal mucinous cystadenocarcinoma and mucus-secreting adenocarcinoma of the renal pelvis, in directing the appropriate management of muconephrosis.

Adenoma, Villous↗