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Rometti M, Patel D, Bryczkowski C. Xanthogranulomatous Pyelonephritis: Case Report. J Emerg Med 2024; 66:e534-e537. [PMID: 38485571 DOI: 10.1016/j.jemermed.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 09/26/2023] [Accepted: 11/23/2023] [Indexed: 04/07/2024]
Abstract
BACKGROUND In the emergency department (ED), pyelonephritis is a fairly common diagnosis, especially in patients with unilateral flank pain. Xanthogranulomatous pyelonephritis (XGP) is a rare type of pyelonephritis that is associated with unique features, which may lead to its diagnosis. CASE REPORT A 30-year-old male patient presented to the ED for evaluation of right-sided abdominal pain that has been ongoing for the past 24 hours. He noted the pain was located predominantly in the right flank and described it as sharp in nature. The pain was nonradiating and was associated with scant hematuria. He stated that he had similar pains approximately 1 month earlier that resolved after a few days. The patient underwent a bedside ultrasound and a subsequent computed tomography (CT) scan of the abdomen and pelvis, which showed an enlarged, multiloculated right kidney with dilated calyces and a large staghorn calculus, findings that represent XGP. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report highlights an unusual variant of pyelonephritis, a relatively common ED diagnosis. XGP should be considered in patients with recurrent pyelonephritis, as treatment for XGP may require surgical intervention in addition to traditional antibiotic management.
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Affiliation(s)
- Mary Rometti
- Emergency Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Depesh Patel
- Emergency Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Kelly C, Anderson S, Looney A, Shannon N, Senaratne R, O'Connor E, Breen K, Lennon G, McGuire B, Murphy M, Moran D, Galvin D. Nephrectomy for xanthogranulomatous pyelonephritis-a not-so-simple solution. Ir J Med Sci 2024; 193:1055-1060. [PMID: 37610600 PMCID: PMC10961261 DOI: 10.1007/s11845-023-03496-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/09/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Xanthogranulomatous pyelonephritis (XGP) is a rare chronic inflammatory condition of the kidney, associated with high patient morbidity, often requiring targeted antibiotic therapy and surgical removal of the affected kidney. AIM We report the outcomes of patients undergoing nephrectomy for XGP in our institution over a 12-year period. METHODS Following ethical approval, a retrospective review of histological samples of renal tissue demonstrating features of XGP from June 2010 to 2022 was conducted. Laboratory, imaging, and clinical data of included participants were collected. RESULTS Eleven patients were included (8 women, 3 men), mean age of 58.1 (35-81). Recurrent urinary tract infection was the most common clinical presentation (55%, n = 6). Other presentations included flank pain (36%, n = 4), collection/ abscess (45%, n = 5), and nephro-cutaneous fistulae (9%, n = 1). The majority of patients had bacteriuria (91%, n = 10), and Escherichia coli was the most common bacteria isolated (55%, n = 6). Antibiotic resistance was seen in 60% of positive urine samples (n = 6). An open nephrectomy was performed in all but one case (91%, n = 10). A postoperative complication occurred in 73% (n = 8), with 50% (n = 4) of complications Clavien Dindo grade 3 or higher, including one patient mortality. CONCLUSIONS XGP is a difficult and complex condition to treat. All patients in this series presented with infection or associated sequelae thereof. Complex XGP cases therefore often require open nephrectomy and have high rates of postoperative complications. Careful consideration of antibiotic and operative intervention is therefore essential to ensure the best outcome for these patients.
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Affiliation(s)
- Caroline Kelly
- Urology Department, St. Vincent's University Hospital, Dublin, Ireland.
| | - Steven Anderson
- Urology Department, St. Vincent's University Hospital, Dublin, Ireland
| | - Aisling Looney
- Urology Department, St. Vincent's University Hospital, Dublin, Ireland
| | - Naomi Shannon
- Urology Department, St. Vincent's University Hospital, Dublin, Ireland
| | - Radha Senaratne
- Urology Department, St. Vincent's University Hospital, Dublin, Ireland
| | - Eabhann O'Connor
- Urology Department, St. Vincent's University Hospital, Dublin, Ireland
| | - Kieran Breen
- Urology Department, St. Vincent's University Hospital, Dublin, Ireland
| | - Gerald Lennon
- Urology Department, St. Vincent's University Hospital, Dublin, Ireland
| | - Barry McGuire
- Urology Department, St. Vincent's University Hospital, Dublin, Ireland
| | - Michael Murphy
- Urology Department, St. Vincent's University Hospital, Dublin, Ireland
| | - Diarmaid Moran
- Urology Department, St. Vincent's University Hospital, Dublin, Ireland
| | - David Galvin
- Urology Department, St. Vincent's University Hospital, Dublin, Ireland
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Telecan T, Andras I, Crousen N, Cata ED, Medan P, Stanca DV, Territo A, Coman I, Crisan N. Laparoscopic approach for xanthogranulomatous pyelonephritis and pyonephrosis. Actas Urol Esp 2024:S2173-5786(24)00026-X. [PMID: 38556126 DOI: 10.1016/j.acuroe.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/17/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Xanthogranulomatous pyelonephritis (XGPN) is a rare form of chronic renal inflammation, caused by long-term obstruction of the urinary tract. Pyonephrosis is a severe suppurative complication of acute obstructive pyelonephritis. Although minimally invasive approaches have many advantages, the safe dissection of the kidney may not be always achievable. MATERIALS AND METHODS We reviewed 27 cases diagnosed with either XGPN or pyonephrosis, who underwent laparoscopic total nephrectomy between October 2016 and March 2022 in our department. All interventions were performed using the Karl Storz 3D laparoscopic system. The surgical approach was standard transperitoneal nephrectomy for the majority of XGPN, while pyonephrosis cases were carried out in a retroperitoneally. All procedures were performed or supervised by the same surgeon. RESULTS The mean operative time was 269.85 minutes (range 145-360). The mean hemoglobin drop after surgery was 1.41 g/dl (range 0.3-2.3 g/dl). Difficult dissection was encountered in 13 cases (48.14%). Nine out of 13 interventions were carried out in a complete intracorporeal fashion, while conversion to open surgery was needed in 4 cases. Vascular complications involving the major blood vessels comprised of one case of inferior vena cava (IVC) tear. Digestive tract-related complications comprised two fistulas of the descending colon and one peritoneal breach. Multiorgan resection was performed in 6 cases. CONCLUSION Total nephrectomy in cases of XGPN and pyonephrosis is a challenging procedure. The laparoscopic approach is feasible, as most complications are resolved intracorporeally. However, it may remain reserved for large-volume centers with experienced surgeons.
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Affiliation(s)
- T Telecan
- Servicio de Urología, Universidad de Medicina y Farmacia Iuliu Hatieganu, Cluj-Napoca, Romania; Servicio de Urología, Hospital Municipal Clínico, Cluj-Napoca, Romania
| | - I Andras
- Servicio de Urología, Universidad de Medicina y Farmacia Iuliu Hatieganu, Cluj-Napoca, Romania; Servicio de Urología, Hospital Municipal Clínico, Cluj-Napoca, Romania.
| | - N Crousen
- Servicio de Urología, Universidad de Medicina y Farmacia Iuliu Hatieganu, Cluj-Napoca, Romania
| | - E D Cata
- Servicio de Urología, Universidad de Medicina y Farmacia Iuliu Hatieganu, Cluj-Napoca, Romania; Servicio de Urología, Hospital Municipal Clínico, Cluj-Napoca, Romania
| | - P Medan
- Servicio de Urología, Universidad de Medicina y Farmacia Iuliu Hatieganu, Cluj-Napoca, Romania; Servicio de Urología, Hospital Municipal Clínico, Cluj-Napoca, Romania
| | - D V Stanca
- Servicio de Urología, Universidad de Medicina y Farmacia Iuliu Hatieganu, Cluj-Napoca, Romania; Servicio de Urología, Hospital Municipal Clínico, Cluj-Napoca, Romania
| | - A Territo
- Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - I Coman
- Servicio de Urología, Universidad de Medicina y Farmacia Iuliu Hatieganu, Cluj-Napoca, Romania
| | - N Crisan
- Servicio de Urología, Universidad de Medicina y Farmacia Iuliu Hatieganu, Cluj-Napoca, Romania; Servicio de Urología, Hospital Municipal Clínico, Cluj-Napoca, Romania
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Robles-Torres JI, García-Chairez LR, Castellani D, Enrriquez-Ávila JV, Monzón-Falconi JF, Esqueda-Mendoza A, Flores-Tapia JP, Wroclawski ML, Duarte-Santos HO, Ragoori D, Gadzhiev N, Mahajan A, Kumar S, Farooq M, Ganpule A, Tanidir Y, Maheshwari PN, Gite VA, Sinha MM, Somani BK, Gutiérrez-González A, Gauhar V. Perioperative outcomes and risk factors for major complications associated with nephrectomy for Xanthogranulomatous pyelonephritis: a multicenter study. World J Urol 2023; 41:2905-2914. [PMID: 37171477 DOI: 10.1007/s00345-023-04415-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/28/2023] [Indexed: 05/13/2023] Open
Abstract
PURPOSE To determine the risk factors associated with major complications in patients with histologically confirmed Xanthogranulomatous pyelonephritis (XGP) who underwent nephrectomy. METHODS A multicenter retrospective study was performed including patients who underwent nephrectomy between 2018 and 2022 with histopathological diagnosis of XGP. Clinical and laboratory parameters at the initial presentation were evaluated. Data on extension of XGP was recorded as per the Malek clinical-radiological classification. Characteristics of nephrectomy and perioperative outcomes were obtained. The primary outcome was major complications, defined as a CD ≥ grade 3 and the need for intensive care unit (ICU) admission. Secondary outcomes included the comparison of complications evaluating the nephrectomy approach (transperitoneal, retroperitoneal, and laparoscopic). A sub-analysis stratifying patients who needed ICU admission and Malek classification was performed. RESULTS A total of 403 patients from 10 centers were included. Major complications were reported in 98 cases (24.3%), and organ injuries were reported in 58 patients (14.4%), being vascular injuries the most frequent (6.2%). Mortality was reported in 5 cases (1.2%). A quick Sepsis-related Organ Failure Assessment (qSOFA) score ≥ 2, increased creatinine, paranephric extension of disease (Malek stage 3), a positive urine culture, and retroperitoneal approach were independent factors associated with major complications. CONCLUSION Counseling patients on factors associated with higher surgical complications is quintessential when managing this disease. Clinical-radiological staging, such as the Malek classification may predict the risk of major complications in patients with XGP who will undergo nephrectomy. A transperitoneal open approach may be the next best option when laparoscopic approach is not feasible.
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Affiliation(s)
| | | | - Daniele Castellani
- Urology Unit Azienda Ospedaliero-Universitaria Delle Marche, Ancona, Italy
| | | | | | | | | | - Marcelo Langer Wroclawski
- Faculdade de Medicina Do ABC, Santo André, São Paulo, SP, Brazil
- BP - a Beneficência Postuguesa de São Paulo, São Paulo, SP, Brazil
| | | | - Deepak Ragoori
- Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India
| | - Nariman Gadzhiev
- Saint Petersburg State University Hospital, St. Petersburg, Russia
| | - Abhay Mahajan
- Mahatma Gandhi Mission's Medical College and Hospital, Aurangabad, India
| | - Santosh Kumar
- Department Urology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mudasir Farooq
- Department Urology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Arvind Ganpule
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | | | | | - Mriganka Mani Sinha
- University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Bhaskar K Somani
- University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | | | - Vineet Gauhar
- Ng Teng Fong General Hospital (NTFGH)/NUHS, Singapore, Singapore
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Harrison W, Gough P, Raveenthiran S, Sillar D. Paediatric xanthogranulomatous pyelonephritis with reno-psoas fistula, psoas abscess and migration of renal calculi. Urol Case Rep 2023; 51:102607. [PMID: 38024507 PMCID: PMC10663763 DOI: 10.1016/j.eucr.2023.102607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/25/2023] [Accepted: 10/29/2023] [Indexed: 12/01/2023] Open
Abstract
Xanthogranulomatous pyelonephritis (XGP) is a rare form of chronic pyelonephritis characterized by granulomatous tissue replacing renal parenchyma, primarily in adults. It's often linked to chronic obstruction, urolithiasis, and pyelonephritis, with rare associations with psoas abscess or fistula. A 15-year-old girl, initially treated conservatively for suspected pyelonephritis, underwent CT imaging due to non-response. This revealed XGP with a sizable psoas abscess caused by a kidney-psoas muscle fistula and renal calculus migration. Treatment involved percutaneous abscess drainage, open right nephrectomy, and a prolonged antibiotic regimen.
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Affiliation(s)
| | - Patrick Gough
- NSW Health, The Tweed Hospital, 16 Powell St, Tweed Heads, NSW, 2560, Australia
| | | | - David Sillar
- NSW Health, The Tweed Hospital, 16 Powell St, Tweed Heads, NSW, 2560, Australia
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Sahel H, Bouguestour N, Merrouche B, Habouchi A, Benmohand C. [Abdominal wall skin nodules revealing xanthogranulomatous pylonephritis]. Rev Med Interne 2023; 44:521-524. [PMID: 37393119 DOI: 10.1016/j.revmed.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/20/2023] [Accepted: 06/19/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION Xanthogranulomatous pyelonephritis is a chronic pyelonephritis characterized by an inflammatory granulomatous reaction that destroys the renal parenchyma. It is an uncommon entity. Diffuse inflammation has the potential to spread to nearby organs, especially the skin. OBSERVATION A 73-year-old patient presented with a three-year history of painful and fistulized nodules on the abdominal wall. The results of abdominal computed tomography and magnetic resonance imaging revealed xanthogranulomatous pyelonephritis with extension to the skin, colon, and psoas muscle. The skin lesions were improved by a double antibiotic therapy. The patient was advised to have a radical left nephrectomy, but he refused surgery and was then lost to follow-up. CONCLUSION We report an uncommon case of xanthogranulomatous pyelonephritis revealed by cutaneous nodules of the abdominal wall, with an extension toward the skin, the colon and the psoas muscle.
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Affiliation(s)
- H Sahel
- Service de dermatologie, CHU Bab El Oued. Said Touati, Bab El Oued 16000, Alger, Algérie.
| | - N Bouguestour
- Service de dermatologie, CHU Bab El Oued. Said Touati, Bab El Oued 16000, Alger, Algérie
| | - B Merrouche
- Service de dermatologie, CHU Bab El Oued. Said Touati, Bab El Oued 16000, Alger, Algérie
| | - A Habouchi
- Service d'imagerie médicale, CHU Bab El Oued, Alger, Algérie
| | - C Benmohand
- Service de dermatologie, CHU Bab El Oued. Said Touati, Bab El Oued 16000, Alger, Algérie
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Chiancone F, Persico F, Fabiano M, Meccariello C, Giannella R, Fedelini M, Lughezzani G, Fedelini P. Comparison of laparoscopic versus open simple nephrectomy in patients with xanthogranulomatous pyelonephritis: A singlecenter analysis of outcomes and predictors of surgical approaches and complications. Curr Urol 2023; 17:135-140. [PMID: 37691987 PMCID: PMC10489480 DOI: 10.1097/cu9.0000000000000067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/13/2021] [Indexed: 11/26/2022] Open
Abstract
Background The aim of this study was to compare the outcomes of open simple nephrectomy and laparoscopic simple nephrectomy in patients with xanthogranulomatous pyelonephritis (XGP) in a single-institutional retrospective study and to identify predictive factors of surgical approaches and complications. Materials and methods We retrospectively analyzed the data of 67 consecutive patients with a histopathological diagnosis of XGP who underwent either open simple nephrectomy (ON) or laparoscopic simple nephrectomy (LN) from January 2014 to April 2020. The primary endpoint was the evaluation of perioperative outcomes and complications. Secondary endpoints were to define factors influencing the surgical approach and the likelihood of postoperative complications. Results Overall, 44 out of 67 patients (65.67%) underwent ON, while 23 (34.33%) underwent LN. Patients in the ON group experienced more postoperative pain according to the visual analogic scale (p = 0.032). Moreover, time to deambulation and time to return to full daily activities, assessed according to the 12-Item Short Form Survey physical and mental component summary scores questionnaires, were significantly shorter in the LN group (p = 0.021, p < 0.001, and p < 0.001, respectively). Of note, there were no significant differences in intraoperative and postoperative complication rates among the groups (p = 0.258 and p = 0.317, respectively). No conversion to open surgery was described. Logistic regression analysis demonstrated that urgency (p = 0.025) was the only predictor associated with a higher risk of intraoperative complications. However, no independent factors associated with postoperative complications or with the surgical approach of choice were found. Conclusions Based on our results, laparoscopic treatment of XGP represents a feasible alternative to ON, resulting in less postoperative pain and faster recovery. In skilled hands, LN should be considered as the treatment of choice for XGP.
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Affiliation(s)
| | - Francesco Persico
- Department of Urology, A.O.R.N. A. Cardarelli, Naples, Italy
- Department of Urology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Marco Fabiano
- Department of Urology, A.O.R.N. A. Cardarelli, Naples, Italy
| | | | | | | | - Giovanni Lughezzani
- Department of Urology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Paolo Fedelini
- Department of Urology, A.O.R.N. A. Cardarelli, Naples, Italy
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Yi M, Liu Y, Chen Q. Xanthogranulomatous pyelonephritis with polycystic kidney disease as a mimic of cystic renal cell carcinoma: a case report. BMC Urol 2023; 23:58. [PMID: 37038156 PMCID: PMC10088123 DOI: 10.1186/s12894-023-01224-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 03/21/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Xanthogranulomatous pyelonephritis (XGP) is a rare chronic pyelonephritis that often mimics other renal diseases, when combined with autosomal dominant polycystic kidney disease(ADPKD), preoperative diagnosis is exceedingly difficult. It is important for clinicians to be aware of an XGP with ADPKD since a misdiagnosis can lead to unnecessary surgical intervention. CASE PRESENTATION Here, we report a case of a 66-year-old female with a history of bilateral ADPKD and urinary tract infection admitted to our hospital due to right flank pain, feeble, and low-grade fever. Contrast-enhanced ultrasound revealed a malignant mass of the right kidney suspected to be a cystic renal cell carcinoma with polycystic kidney disease. In addition, contrast-enhanced computed tomography (CT) and fluorine 18 fluorodeoxyglucose PET/CT (18F FDG PET/CT) showed similar results. Subsequently, the patient underwent a right radical nephrectomy, but histopathological examination revealed XGP with ADPKD. On the follow-up, the patient's symptoms were relieved. CONCLUSIONS XGP should be kept in mind during the differential diagnosis of renal masses with ADPKD even in the absence of characteristic clinical symptoms and imaging manifestations.
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Affiliation(s)
- Mei Yi
- Department of Ultrasound, Capital Medical University Affiliated Beijing Shijitan Hospital, No. 10 Tieyi St, Haidian District, Beijing, 100038, China
| | - Yong Liu
- Department of Ultrasound, Capital Medical University Affiliated Beijing Shijitan Hospital, No. 10 Tieyi St, Haidian District, Beijing, 100038, China.
| | - Qi Chen
- Department of Ultrasound, Capital Medical University Affiliated Beijing Shijitan Hospital, No. 10 Tieyi St, Haidian District, Beijing, 100038, China
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Kazemi R, Paymannejad S. A case of xanthogranulomatous pyelonephritis leading to nephrobronchial fistula and lung abscess: does it always manifest with respiratory symptoms? Am J Clin Exp Urol 2022; 10:358-365. [PMID: 36313207 PMCID: PMC9605941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Xanthogranulomatous pyelonephritis (XGP) is a serious manifestation of chronic kidney inflammation that can expand to adjacent structures. Here we report a case of XGP extending beyond the diaphragm through a nephrobronchial fistula to form a lung abscess in a 70-year-old man. The patient presented to the emergency department with severe right flank colic pain, nausea, vomiting and nonspecific constitutional symptoms for the past 4 months. Although the patient did not complain of any respiratory symptoms, initial evaluations revealed severe right-sided hydroureteronephrosis with debris, as well as an area of infiltration in the right lung lower lobe (RLL). Given the patient's condition, a thorough work-up was expedited to investigate the potential association between the symptoms. Ultimately, a diagnosis of XGP with expansion to the RLL through the right hemidiaphragm was developed. A right radical nephrectomy, right lower lobectomy and right hemidiaphragm resection were carried out. XGP was confirmed on the basis of the pathological evaluation of the resected specimens.
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Affiliation(s)
- Reza Kazemi
- Department of Urology, School of Medicine, Isfahan University of Medical Sciences Isfahan, Iran
| | - Saina Paymannejad
- Department of Urology, School of Medicine, Isfahan University of Medical Sciences Isfahan, Iran
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Julson JR, Sibat Noor MD, Williams AP, Wicker J, Beierle EA. A pediatric case of xanthogranulomatous pyelonephritis in the setting of Covid-19 and multi-system inflammatory syndrome (MIS-C). J Pediatr Surg Case Rep 2022; 84:102359. [PMID: 35754931 PMCID: PMC9214769 DOI: 10.1016/j.epsc.2022.102359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/20/2022] [Indexed: 11/19/2022] Open
Abstract
Xanthogranulmatous pyelonephritis is a rare, chronic inflammatory pathology of the kidney. It most commonly arises in middle-aged females, but there are case reports and series described in the pediatric population. Here, we discuss the case of a 14 year old male who presented with xanthogranulomatous pyelonephritis in the setting of Covid-19 and multi-system inflammatory syndrome (MIS-C). As xanthogranulomatous pyelonephritis often mimics other diseases that are more prevalent in the pediatric population, our case was only definitively diagnosed with histopathology after surgical resection. This report is novel in that, to our knowledge, it is the first to describe xanthogranulomatous pyelonephritis in the setting of MIS-C.
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Affiliation(s)
- Janet R Julson
- Division of Pediatric Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - M D Sibat Noor
- Division of Pediatric Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Adele P Williams
- Division of Pediatric Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Jason Wicker
- Department of Pathology, The Children's Hospital of Alabama, Birmingham, AL, 35233, USA
| | - Elizabeth A Beierle
- Division of Pediatric Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
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Chatterjee A, Herrera Hernandez LP, de la Fuente J. Xanthogranulomatous Pyelonephritis. Am J Med Sci 2022; 364:e13-e14. [PMID: 35122727 DOI: 10.1016/j.amjms.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 10/08/2021] [Accepted: 01/26/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Arjun Chatterjee
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jaime de la Fuente
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
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Moudi E, Darzi M, Ramzani S, Akbarzadeh Pasha A. Xanthogranulomatous pyelonephritis combined with emphysematous pyelonephritis: A rare case report. Caspian J Intern Med 2021; 12:S505-S508. [PMID: 34760116 PMCID: PMC8559650 DOI: 10.22088/cjim.12.0.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 11/28/2022]
Abstract
Background: Xanthogranulomatous pyelonephritis (XGP) is a rare and intense type of chronic kidney infection characterized by subversion of the renal tissue and its replacement by lipid- laden macrophages. XGP combined with emphysematous pyelonephritis(EPN) is rare and up until now only 7 cases with these presentations have been reported; so abundant clinical skills and appropriate radiographic imaging is required to reach the correct diagnosis. In this report, we present a case with two uncommon variants of pyelonephritis. Case Presentation: A 55-year-old female presented with a history of type 2 diabetes mellitus, and a stroke leading to a left-sided hemiplegia state for 7 years, coronary artery bypass grafting(CABG), hypertension(HTN) , seizure, progressive fatigue, loss of appetite , fecal and urinary incontinence and right costovertebral angle tenderness. According to clinical signs, symptoms and documentation of gas within the renal parenchyma on computed tomography (CT) of abdomen, of EPN diagnosis was suggested; however histopathologic evaluation showed acute emphysematous pyelonephritis on chronic xanthogranulomatous pyelonephritis. Conclusion: EPN can emerge in a patient suffering from XPG which would add to the severity of the situation. In the case presented, concurrent underlying diseases such as diabetes mellitus, stroke, CABG, HTN along with severe fatigue and loss of appetite existed. Surgical treatment produces dramatic results.
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Affiliation(s)
- Emadoddin Moudi
- Department of Urology, Babol University of Medical Sciences, Babol, Iran.,Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mohammadmehdi Darzi
- Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.,Clinical Research Development Center, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, I.R.Iran
| | - Sepehr Ramzani
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran.,Faculty of Medicine, Babol University of Medical Science, Babol, Iran
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13
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Ariyono A, Pudjohartono MF, Rikl T, Rinonce HT, Irawiraman H, Setyorini YP, Tumedia D. Xanthogranulomatous Pyelonephritis with Pyonephrosis and Renal Abscess in a Young Adult: A Consequence of Neglected Urinary Tract Infection Leading to Nephrectomy. Acta Med Indones 2021; 53:469-472. [PMID: 35027496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Xanthogranulomatous pyelonephritis (XGP) is a rare form of chronic pyelonephritis, which is challenging to diagnose because its clinical presentation mimics other entities and is commonly associated with a history of urinary tract obstruction. We report a case of XGP in a young adult without nephrolithiasis and urinary tract obstruction. A 23-year-old woman presented with intermittent abdominal pain in the right upper quadrant persisting for the last ten months. The pain was dull, poorly localized, and started spreading to the right back, right shoulder, and right thigh in the last three months. Other complaints included fever, chills, pain during urination, and nausea. The patient had a history of infrequent urination, recurrent urinary tract infections (UTIs), and a low fluid intake. A physical examination revealed that the patient had right upper quadrant abdominal tenderness and right costovertebral angle tenderness. Laboratory findings showed leukocytosis and neutrophilia. The radiological examination revealed a round mass in the superior pole of the right kidney with mixed cystic and solid components, and a well-defined margin. It further enlarged from 4.5 cm to 10.6 cm in diameter in three months. The urologist performed a total right nephrectomy. The histopathological examination showed XGP with renal abscess. Proteus mirabilis was identified from the pus specimen culture. XGP should be considered in the diagnosis of patients having chronic UTI presented with or without the findings of urinary tract obstruction.
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Affiliation(s)
- Ali Ariyono
- Department of Anatomical Pathology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia.
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14
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Tamburrini S, Fiorini V, Lugarà M, Napodano G, Del Biondo D, Squame F, Sarti G, Quassone P, Coppola MG, Iannuzzi M, Di Stasio M, Shatalova O, Marano I, Cagini L. Nephrobronchial fistula a case report and review of the literature. Radiol Case Rep 2021; 16:3470-3477. [PMID: 34539942 PMCID: PMC8440951 DOI: 10.1016/j.radcr.2021.08.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 08/11/2021] [Indexed: 12/23/2022] Open
Abstract
Nephrobronchial fistula is an extremely rare complications of renal infections. We present a case of nephrobronchial fistula in a middle age immunocompetent woman who complained cough and weight loss, with underlying asymptomatic nephrolithiasis. She underwent a chest X-ray that showed left lower lobe infiltrate and abdominal ultrasound. Abdominal ultrasound showed a complicated pyonephrosis ; CT of chest-abdomen-pelvis with intravenous contrast was performed in order to stage and define the extension of the pathology. At CT, a suspected diagnosis of stage III xanthogranulomatous pyelonephritis complicated with pyonephrosis and a nephrobronchial fistula was formulated. A nephrostomy tube was placed, and the patient was treated with antibiotics. Follow up CT, performed after 15 days, showed the healing of the fistulous connection between the perinephric abscess and bronchi; the patient underwent nephrectomy with no airway complication during intubation. Histopathological diagnosis confirmed the presence on complicated xanthogranulomatous pyelonephritis.
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Affiliation(s)
| | - Valeria Fiorini
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Marina Lugarà
- Department of Internal Medicine, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Giorgio Napodano
- Department of Urology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Dario Del Biondo
- Department of Urology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Fiorenzo Squame
- Department of Nuclear Medicine, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Giuseppe Sarti
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Pasquale Quassone
- Department of Radiology, "Università degli Studi della Campania Luigi Vanvitelli", Naples, Italy
| | | | - Michele Iannuzzi
- Department of Anesthesiology and Intensive Care, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Mario Di Stasio
- Department of Thoracic Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Olena Shatalova
- Department of Thoracic Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Ines Marano
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Lucio Cagini
- Department of Thoracic Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
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15
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Mhmed Ali R, Haidar M. Xanthogranulomatous pyelonephritis, and emphysematous pyelonephritis: Two rare conditions in one patient. Ann Med Surg (Lond) 2021; 69:102767. [PMID: 34471534 PMCID: PMC8387895 DOI: 10.1016/j.amsu.2021.102767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/22/2021] [Accepted: 08/22/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction What makes this case unique are combined features of two rare renal disease processes in one patient within one kidney which are Xanthogranulomatous pyelonephritis,and emphysematous pyelonephritis. Case presentation The patient had main general symptoms like fever, chills, fatigue,and right abdominal pain. He had urea = 77, White Blood Cells = 15,46, and urine culture was positive for Klebsiella. He had right total nephrectomy as a therapeutic intervention. Conclusion It is important to note that it could we have two diseases or more in one case related to one systemic organ so, we have to evaluate all possible causes of current status of the patient. Xanthogranulomatous pyelonephritis is a distinct uncommon variant of chronic pyelonephritis. Emphysematous pyelonephritis is also a rare condition. The main cause of xanthogranulomatous pyelonephritis is Escherichia coli followed by proteus organisms. The main treatment for both conditions is total nephrectomy.
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Affiliation(s)
- Rihan Mhmed Ali
- Corresponding author. Faculty of Medicine, Damascus University, Damascus, Damascus, Ruken Aldin, Syrian Arab Republic.
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16
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Chiron P, Savoie PH, Boissier R, Long JA. [Rare emergencies in urology]. Prog Urol 2021; 31:987-1000. [PMID: 34419373 DOI: 10.1016/j.purol.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 07/22/2021] [Accepted: 08/02/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aim of this article was to cite rare but sometimes serious emergencies that may be encountered by any urologist during their practice, and to outline the main principles of their management. MATERIAL AND METHOD A systematic review of the literature using PubMed, Embase and Google Scholar was carried out between January 2000 and June 2021. The articles obtained were selected according to their age and type. The original articles, meta-analyses, recommendations and the most recent journal articles published in French and English have been retained. A total of 312 articles were identified and 58 selected from their abstracts. The articles were then analysed exhaustively by the authors, and 24 references were finally selected. RESULTS Several rare emergencies of an infectious nature (xanthogranulomatous pyelonephritis, emphysematous cystitis and pyelonephritis, malacoplasia, hydatiduria), ischemic nature (Fournier's gangrene, penile calciphylaxis), or hemorrhagic nature (hemospermia, hemorrhages of the upper urinary tract or adrenal gland spontaneous hematoma), or at the origin of painful manifestations (spermatic colic, venous thrombosis of the penis), can pose diagnostic and therapeutic difficulties, in the absence of consensus concerning their management. CONCLUSION These pathologies, rare but sometimes serious, must be recognized in order to not delay the treatment and to be able to reduce their morbidity and mortality. Combined with the constant improvement of our diagnostic and therapeutic arsenal, a better knowledge of these rare emergencies will help to preserve the functional and vital prognosis of patients.
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Affiliation(s)
- P Chiron
- Service d'urologie, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
| | - P-H Savoie
- Service d'urologie, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - R Boissier
- Service de chirurgie urologique et de transplantation rénale, Aix-Marseille université, centre hospitalier universitaire de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - J-A Long
- Service d'urologie et de la transplantation rénale, centre hospitalier universitaire de Grenoble Alpes, avenue des Maquis du Grésivaudan, 38700 La Tronche, France
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17
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Abushamma F, Barqawi A, Akkawi M, Maree M, Jaradat A, Aghbar A. Laparoscopic heminephrectomy in a horseshoe kidney affected by xanthogranulomatous pyelonephritis: A modified approach. Urol Case Rep 2021; 38:101717. [PMID: 34040991 PMCID: PMC8141470 DOI: 10.1016/j.eucr.2021.101717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 05/11/2021] [Indexed: 12/03/2022] Open
Abstract
Horseshoe kidney (HSK) is a common congenital kidney anomaly that is encountered frequently by urologists. It is rare for HSK to be affected by xanthogranulomatous pyelonephritis (XGP), a potentially life-threatening condition. The standard of care for XGP is open nephrectomy, but recently a few case reports have been published showing the feasibility of minimally invasive surgery to deal with XGP. We present a case of HSK affected by XGP treated successfully with modified laparoscopic transperitoneal heminephrectomy. The rarity of such a combination, the modified approach, and the successful outcome encouraged us to report it.
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Affiliation(s)
- Faris Abushamma
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.,Department of Urology, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Abdulkarim Barqawi
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.,Department of General Surgery, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Maha Akkawi
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.,Department of Pathology, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Mosab Maree
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.,Department of Radiology, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Ahmad Jaradat
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.,Department of Urology, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Amir Aghbar
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.,Department of Urology, An-Najah National University Hospital, Nablus, 44839, Palestine
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18
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Avilés-Ibarra OJ, Maldonado-Alcaraz E, Carrasco-González Á, León-Mar R, López-Samano VA, Rodríguez-Jasso VH, Moreno-Palacios J. Factores de riesgo preoperatorios en pacientes con pielonefritis xantogranulomatosa sometidos a nefrectomía. CIR CIR 2021; 89:411-415. [PMID: 34037619 DOI: 10.24875/ciru.20000108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJETIVO Identificar factores de riesgo asociados a complicaciones mayores en pacientes con pielonefritis xantogranulomatosa sometidos a nefrectomía. MÉTODO Análisis retrospectivo de expedientes clínicos de pacientes con pielonefritis xantogranulomatosa sometidos a nefrectomía. Se analizaron el sexo, el índice de masa corporal, el índice de comorbilidad de Charlson, la clasificación del estado físico de la American Society of Anesthesiologists, la etapa de Malek, el conteo leucocitario y los valores de creatinina. Las complicaciones se estratificaron en menores y mayores según la clasificación de Clavien-Dindo. Se realizó análisis univariado y bivariado usando las pruebas exacta de Fisher y ji al cuadrado de Pearson, y se establecieron medidas de riesgo utilizando la odds ratio (OR). RESULTADOS Se analizaron 72 pacientes con una edad media de 50 años, el 83% mujeres, el 58.3% con urocultivo positivo y el 66% con litiasis renal. El 32% tuvieron alguna complicación mayor y el 15% requirieron admisión a la unidad de cuidados intensivos. Los valores elevados de creatinina (OR: 3.8; intervalo de confianza del 95% [IC95%]: 1.1-13; p = 0.02) y la etapa Malek II-III (OR: 4.5; IC95%: 1.2-17.5; p = 0.02) se asociaron con complicaciones mayores. CONCLUSIÓN El estadio de Malek y los valores elevados de creatinina incrementan el riesgo de desarrollar complicaciones mayores en los pacientes con pielonefritis xantogranulomatosa sometidos a nefrectomía. OBJECTIVE To identify preoperative risk factors associated with major complications in patients with xanthogranulomatous pyelonephritis undergoing total nephrectomy. METHOD Retrospective analysis of patient’s charts with xanthogranulomatous pyelonephritis who underwent nephrectomy. Risk factors included for analysis were gender, body mass index, Charlson comorbidity index, American Society of Anesthesiologists physical status classification, Malek’s stage, leukocyte count and creatinine levels. Postoperative complications were stratified in minor and major according to Clavien-Dindo’s classification. Univariate and bivariate analysis using Fisher’s exact test, Pearson’s chi-squared and odds ratio (OR) was performed. RESULTS 72 patients were analyzed, 83% women, mean age of 50 years, 58.3% positive urine cultures and 66% kidney stones. Major complications were present in 32% of cases, and 15% were admitted to the intensive care unit. Elevated creatinine (OR: 3.8; 95% confidence interval [95%CI]: 1.1-13; p = 0.02) and Malek’s stage II to III (OR: 4.5; 95%CI: 1.2-17.5; p = 0.02) were associated with major complications. CONCLUSION The Malek Stage and elevated creatinine increases the risk of major complications in patients undergoing nephrectomy due to xanthogranulomatous pyelonephritis.
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Affiliation(s)
- Oswaldo J Avilés-Ibarra
- Departamento de Urología, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Efraín Maldonado-Alcaraz
- Departamento de Urología, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Álvaro Carrasco-González
- Departamento de Urología, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Rodrigo León-Mar
- Departamento de Urología, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Virgilio A López-Samano
- Departamento de Urología, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Víctor H Rodríguez-Jasso
- Departamento de Urología, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Jorge Moreno-Palacios
- Departamento de Urología, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
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Mremi A, Ngowi BN, Bright F, Pallangyo A, Mbwambo OJ. Xanthogranulomatous pyelonephritis in an eight year old male child: A case report and review of the literature. Int J Surg Case Rep 2021; 82:105943. [PMID: 33964721 PMCID: PMC8114108 DOI: 10.1016/j.ijscr.2021.105943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction and importance Xanthogranulomatous pyelonephritis is an extremely rare but known form of chronic pyelonephritis resulting from prolonged suppuration of the kidney. Pre-operatively, it may mimic renal tuberculosis or neoplastic lesions including renal cell carcinoma due to its vague clinical presentation, equivocal laboratory and radiological investigations. Due to its rarity and academic interest, herein we report such a rare case we recently encountered in our clinical practice. Case presentation An-eight-year old male child patient resented to our hospital with three months history of abdominal distension associated with progressive left flank pain. Preoperative investigations including CT-scan were suggestive of nephroblastoma with differential diagnosis of clear cell sarcoma. Radical nephrectomy was performed and histopathology of the specimen confirmed the diagnosis of Xanthogranulomatous pyelonephritis. The patient fared well postoperatively and he had no symptoms in the subsequent follow up visits. Clinical discussion Xanthogranulomatous pyelonephritis is a rare, severe and atypical form of chronic pyelonephritis due to infection (E. coli, Proteus) or stones. The disease may resemble renal cell carcinoma preoperatively. Thus, high index of suspicion is necessary for preoperative diagnosis. Conclusion Preoperative diagnosis of Xanthogranulomatous pyelonephritis may be a daunting task related to the rarity of its presentation. Thus, scrupulous histopathological evaluation is essential for the definitive diagnosis. Radical nephrectomy is the mainstay treatment of choice especially in diffuse cases. Extremely rare and severe form of chronic pyelonephritis Resulting from prolonged suppuration of the kidney May mimic cancer due to vague clinical presentation, equivocal lab and imaging tests Confirmatory diagnosis is based on histopathological examination. Nephrectomy remains the treatment of choice in almost all cases.
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Affiliation(s)
- Alex Mremi
- Department of Pathology, Kilimanjaro Christian Medical Centre, Box 3010, Moshi, Tanzania; Faculty of Medicine, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania.
| | - Bartholomeo N Ngowi
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania; Department of Urology, Kilimanjaro Christian Medical Centre, Box 3010, Moshi, Tanzania
| | - Frank Bright
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania; Department of Urology, Kilimanjaro Christian Medical Centre, Box 3010, Moshi, Tanzania
| | - Angela Pallangyo
- Department of Pathology, Kilimanjaro Christian Medical Centre, Box 3010, Moshi, Tanzania; Faculty of Medicine, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania
| | - Orgeness J Mbwambo
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania; Department of Urology, Kilimanjaro Christian Medical Centre, Box 3010, Moshi, Tanzania
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20
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Artiles-Medina A, Laso-García I, Lorca-Álvaro J, Mata-Alcaraz M, Duque-Ruiz G, Hevia-Palacios M, Arias-Funez F, Burgos-Revilla FJ. Xanthogranulomatous pyelonephritis: a focus on microbiological and antibiotic resistance profiles. BMC Urol 2021; 21:56. [PMID: 33827527 PMCID: PMC8026091 DOI: 10.1186/s12894-021-00800-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/17/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Xanthogranulomatous pyelonephritis (XGP) is an inflammatory condition of the kidney and its treatment most often involves a combination of antibiotics and nephrectomy. This study aimed to define the clinical features and management of XGP, focusing on microbiological aspects and antibiotic therapy. METHODS We performed a retrospective study of 27 cases of XGP diagnosed between January 2001 and January 2020 to analyse their clinical and management characteristics. In addition, a literature review was conducted of XGP case series covering the period from 2000-2020. We searched PubMed for case series through April 2020 without language restrictions. Studies reporting case series of XGP (more than ten cases) were included if they were relevant to this study. RESULTS Twenty-seven patients were diagnosed with XGP, and 26 of them were histologically proven to have XGP. A total of 81.5% of the patients were female and the mean age was 59.6 years (SD 19.2). The most frequent symptoms were flank pain (70.4%) and fever (59.3%), while 77.8% of patients had renal stones. Proteus mirabilis was detected in the urine culture in 18.5% of patients, followed by detection of Escherichia coli in 14.8% of patients. The computed tomography (CT) findings included perirenal (29.6%) or pararenal (29.6%) involvement in the majority of patients. Twenty-six patients underwent nephrectomy. Piperacillin/tazobactam and ceftriaxone were the most commonly prescribed antibiotics for treatment. The reported piperacillin/tazobactam and ceftriaxone resistance rates were 14.3% and 16.6%, respectively. Twenty-six case series were included in the literature review, reporting 693 cases in total. CONCLUSION We found well-established characteristics of XGP patients among series in terms of previous history, clinical, laboratory and imaging findings, and operative and postoperative outcomes. It is important to know the clinical presentation and potential severity of XGP, as well as the most frequently involved microorganisms and their antibiotic resistance profiles, to select the most appropriate antibiotic therapy.
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Affiliation(s)
- A Artiles-Medina
- Department of Urology, Hospital Universitario Ramón Y Cajal. Instituto Ramón Y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
| | - I Laso-García
- Department of Urology, Hospital Universitario Ramón Y Cajal. Instituto Ramón Y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - J Lorca-Álvaro
- Department of Urology, Hospital Universitario Ramón Y Cajal. Instituto Ramón Y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - M Mata-Alcaraz
- Department of Urology, Hospital Universitario Ramón Y Cajal. Instituto Ramón Y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - G Duque-Ruiz
- Department of Urology, Hospital Universitario Ramón Y Cajal. Instituto Ramón Y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - M Hevia-Palacios
- Department of Urology, Hospital Universitario Ramón Y Cajal. Instituto Ramón Y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - F Arias-Funez
- Department of Urology, Hospital Universitario Ramón Y Cajal. Instituto Ramón Y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - F J Burgos-Revilla
- Department of Urology, Hospital Universitario Ramón Y Cajal. Instituto Ramón Y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
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21
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Abhishek C, Kalpesh P, Saket S, Naik B, Santosh K. Xanthogranulomatous pyelonephritis: a rare presentation of disbelieved renal cell cancer recurrence after nephron-sparing surgery. Ann R Coll Surg Engl 2021; 103:e120-e123. [PMID: 33682448 DOI: 10.1308/rcsann.2020.7049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Xanthogranulomatous pyelonephritis is a rare, painful inflammatory subtype of chronic renal infection, which can lead to severe parenchymal destruction. It imitates virtually every other renal inflammatory disease. We report a 51-year-old male presenting with left flank pain, on evaluation found to have a renal mass with a history of nephron-sparing surgery in the same kidney performed 6 months previously. Radical nephrectomy was carried out and histopathology was suggestive of xanthogranulomatous pyelonephritis rather than renal cell cancer recurrence.
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Abstract
Xanthogranulomatous pyelonephritis is a rare and chronic form of pyelonephritis. Patients can present with an array of signs and symptoms including flank pain, fever and weight loss. The insidious nature of its clinical presentation means that it can mimic a neoplastic process. Kidney stone disease, diabetes and female gender are the most common associated factors. Early diagnosis can be difficult, but is vital to avoid sequelae such as abscess formation and involvement of surrounding structures. Management requires a multidisciplinary approach. Definitive resolution can only be achieved through nephrectomy. This article provides an overview and guide to diagnosis, investigation and management.
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Affiliation(s)
- Patrick Jones
- Department of Urology, Great Western Hospital, Swindon, UK
| | - Darko Lazic
- Department of Pathology, Great Western Hospital, Swindon, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
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Abstract
Xanthogranulomatous pyelonephritis (XGP) is a rare chronic suppurative granulomatous infection of the kidney associated with renal obstruction and progressive renal parenchymal destruction. We present an unusual clinically occult case of extensive right XGP which presented clinically with discharging right gluteal sinus and swollen right posterolateral chest and abdominal walls extending caudally to right gluteus. Contrast enhanced computed tomography of the abdomen and pelvis revealed obstructing right renal calculi, severe hydronephrosis, renal destruction and large (20.7 × 10.2 × 14.7 cm) abscess extending caudally to right gluteus. Histopathology of the specimen was concluded as right xanthogranulomatous pyelonephritis. This case demonstrates how distant an insidious XGP can infiltrate. It also emphasizes the need to have a broad range of differential diagnoses including XGP when presented with a case of gluteal abscess and sinus. Contrast enhanced computed tomography plays a key role in evaluating the cause, extent and complications of XGP and is also useful in pretreatment planning.
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Affiliation(s)
- Zablon Bett
- Department of Radiology and Imaging, Maseno University School of Medicine, Kericho 1777 Kenya
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Ciccarese F, Brandi N, Corcioni B, Golfieri R, Gaudiano C. Complicated pyelonephritis associated with chronic renal stone disease. Radiol Med 2020; 126:505-516. [PMID: 33245481 PMCID: PMC8007507 DOI: 10.1007/s11547-020-01315-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/16/2020] [Indexed: 12/31/2022]
Abstract
Purpose This article reviews imaging manifestations of complicated pyelonephritis associated with chronic renal stones disease, in particular xanthogranulomatous pyelonephritis (XGP) and emphysematous pyelonephritis (EPN), as potential mimics of other renal diseases and malignances and provides helpful tips and differentiating features that may alert the radiologist to suspect a diagnosis of infection. Materials and methods A retrospective review of the records from 6 adult patients (5 females and 1 male, mean age 72,3 years) with diagnosis of XGP associated with chronic nephrolithiasis and 7 adult patients (6 females and 1 male, mean age 59,3 years) with diagnosis of EPN associated with chronic nephrolithiasis from January 2010 to January 2020 was carried out. Computed tomography urography (CTU) with at least an unenhanced scan, and the parenchymal and excretory phases after contrast medium administration performed at our Teaching Hospital were included. When available images related to conventional radiography, ultrasound (US) and magnetic resonance imaging of the same patients, the comparison with CTU images was carried out. Conclusion A possible diagnosis of XGP or EPN must always be taken into account when a pyelonephritis is associated with untreated kidney stones, especially whenever clinical presentation is atypical, current therapy is not effective and imaging shows features of dubious interpretation. Due to their rarity and atypical presentation, a multidisciplinary approach is required and an expert radiologist represents a key figure in the multidisciplinary team as he can help to differentiate between benign and malignant lesions and thus avoid unnecessary radical surgical procedures.
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Affiliation(s)
- Federica Ciccarese
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Nicolò Brandi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy.
| | - Beniamino Corcioni
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Caterina Gaudiano
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
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Barboza MP, Nottingham CU, Calaway AC, Wei T, Flack CK, Cary C, Boris RS. Xanthogranulomatous pyelonephritis: a comparison of open and minimally-invasive surgical approaches. J Robot Surg 2020; 15:611-617. [PMID: 33000399 DOI: 10.1007/s11701-020-01153-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/25/2020] [Indexed: 11/28/2022]
Abstract
To compare perioperative outcomes between patients undergoing minimally-invasive (MIS) and open surgical approaches for the treatment of Xanthogranulomatous Pyelonephritis (XGP). Between 2007 and 2017 we retrospectively identified 40 patients undergoing nephrectomy at our institution for pathologically confirmed XGP. Patients whose operations were ultimately completed with open technique were analyzed with the open cohort, whereas patients whose operations were completed in entirety using any laparoscopic approach were analyzed with the MIS group. Twenty-three patients were analyzed in the open cohort, compared to seventeen in the MIS group. Three patients in the open cohort were converted intraoperatively from MIS to open approach. Compared to the open group, the MIS group less often had an abscess on preoperative CT (11.8% vs 54.5%; p = 0.006). The MIS group also had lower intraoperative blood loss (100 vs 400 mL; p < 0.001), lower rate of blood transfusion (0% vs 45.5%; p = 0.002), lower postoperative intensive care admission (0% vs 34.8%; p = 0.013), and shorter hospital stay (4 vs 7 days; p = 0.013). However, there was no significant difference in high-grade complications between these groups (5.9% vs 34.8%; p = 0.054). Preoperative CT scan may be an important factor when considering operative approach for treatment of XGP. Patients who are able to undergo MIS approach have less blood loss, shorter hospitalization, and are less likely to require intensive care admission, which may be related to the disease process, the surgical technique, or both.
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Affiliation(s)
- Marcelo Panizzutti Barboza
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, RT 150, Indianapolis, IN, 46202, USA
| | - Charles U Nottingham
- Department of Surgery, Division of Urology, Washington University School of Medicine, 1044 N Mason Road, Suite 230, Creve Coeur, MO, 63141, USA.
| | - Adam C Calaway
- Case Western Reserve School of Medicine, Urology Institute, 11000 Euclid Ave, Lakeside Building, 4th Floor, Cleveland, OH, 44106, USA
| | - Ting Wei
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, RT 150, Indianapolis, IN, 46202, USA
| | - Chandra K Flack
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, RT 150, Indianapolis, IN, 46202, USA
| | - Clint Cary
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, RT 150, Indianapolis, IN, 46202, USA
| | - Ronald S Boris
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, RT 150, Indianapolis, IN, 46202, USA
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Ding X, Wang G, Wang T, Ma X, Wang Y. Atypical focal xanthogranulomatous pyelonephritis without clinical symptoms presenting as infiltrative renal cancer: a case report and literature review. BMC Urol 2020; 20:63. [PMID: 32493295 PMCID: PMC7268720 DOI: 10.1186/s12894-020-00632-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 05/21/2020] [Indexed: 01/16/2023] Open
Abstract
Background Xanthogranulomatous pyelonephritis (XGP) is an uncommon form of chronic pyelonephritis. Most patients of XGP are diffuse in radiology and the clinical features are typical. Case presentation We present a case of 24-year-old female with the absence of symptoms and normal laboratory examinations. Contrast computed tomography and intravenous pyelography demonstrate infiltrative renal mass and renal cell carcinoma is presumed. Laparoscopic right radical nephrectomy is performed, but the final pathological result shows XGP. Conclusions As far as we know, this is the first case report of XGP without any symptoms/signs and with normal laboratory examinations. The diagnosis of atypical XGP is challenging and preoperative renal mass biopsy should be considered in special cases.
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Affiliation(s)
- Xiaobo Ding
- Department of Radiology, First Hospital of Jilin University, Changchun, Jilin, 130021, P.R. China
| | - Gang Wang
- Second Operating Room, First Hospital of Jilin University, Changchun, Jilin, 130021, P.R. China
| | - Tiejun Wang
- Department of Orthopedic Traumatology, First Hospital of Jilin University, Changchun, Jilin, 130021, P.R. China
| | - Xiaobo Ma
- Department of Pathology, First Hospital of Jilin University, Changchun, Jilin, 130021, P.R. China
| | - Yanbo Wang
- Department of Urology, First Hospital of Jilin University, Changchun, Jilin, 130021, P.R. China.
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Çamlar SA, Öztük T, Soylu A, Türkmen MA, Özer E, Olguner M, Güleryüz H, Kavukçu S. Renal mass in a 2-year-old girl: Answers. Pediatr Nephrol 2019; 34:1039-1041. [PMID: 30535982 DOI: 10.1007/s00467-018-4146-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 11/02/2018] [Accepted: 11/06/2018] [Indexed: 02/05/2023]
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El-Asmar JM, Ghanem R, Ghandour R, Al-Halabi E, Degheili JA. Postpartum xanthogranulomatous pyelonephritis: A case report. Case Rep Womens Health 2019; 22:e00112. [PMID: 31032181 PMCID: PMC6479073 DOI: 10.1016/j.crwh.2019.e00112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/16/2019] [Accepted: 03/26/2019] [Indexed: 11/30/2022] Open
Abstract
Xanthogranulomatous pyelonephritis (XGP) is seldom seen nowadays due to the aggressive treatment of upper urinary tract infections as well as recent advances in the management of urolithiasis. It has been rarely reported in the peri-partum period. We present a case of XGP without any evidence of renal calculi, manifesting in a 26-year-old previously healthy woman immediately post-partum. Xanthogranulomatous pyelonephritis is rare due to the aggressive treatment of upper urinary tract infections and urolithiasis. It has been rarely reported in the peri-partum period. A post-partum 26-year-old woman developed acute xanthogranulomatous pyelonephritis, without any evidence of renal calculi.
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Affiliation(s)
- Jose M El-Asmar
- Division of Urology, Department of Surgery, American University of Beirut - Medical Center, Riad El-Solh, 1107 2020 Beirut, Lebanon
| | - Rayan Ghanem
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Riad El-Solh, 1107 2020 Beirut, Lebanon
| | - Rashed Ghandour
- Division of Urology, Department of Surgery, American University of Beirut - Medical Center, Riad El-Solh, 1107 2020 Beirut, Lebanon
| | - Eliane Al-Halabi
- Department of Anesthesiology, American University of Beirut - Medical Center, Riad El-Solh, 1107 2020, Beirut, Lebanon
| | - Jad A Degheili
- Division of Urology, Department of Surgery, American University of Beirut - Medical Center, Riad El-Solh, 1107 2020 Beirut, Lebanon
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Morales C, Opazo V, Bassa C, López L, Araos F, Madrid P, Morales I. Xanthogranulomatous pyelonephritis: A case report. Urol Case Rep 2018; 19:65-66. [PMID: 29888197 PMCID: PMC5991320 DOI: 10.1016/j.eucr.2018.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 05/01/2018] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Valentina Opazo
- School of Medicine, Universidad de Los Andes, Santiago, Chile
| | - Cristóbal Bassa
- Resident of Urology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis López
- Department of Surgery, Universidad de Los Andes, Santiago, Chile
| | | | | | - Ignacio Morales
- Department of Surgery, Universidad de Los Andes, Santiago, Chile
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Ballentine WK, Vilson F, Dyer RB, Mirzazadeh M. Nephron-sparing management of Xanthogranulomatous pyelonephritis presenting as spontaneous renal hemorrhage: a case report and literature review. BMC Urol 2018; 18:57. [PMID: 29866085 PMCID: PMC5987594 DOI: 10.1186/s12894-018-0354-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 05/02/2018] [Indexed: 11/28/2022] Open
Abstract
Background Xanthogranulomatous pyelonephritis (XGP) is an uncommon infectious disease of the kidney known to mimic other renal maladies. A rare presentation of this uncommon disease is spontaneous renal hemorrhage (SRH). Case presentation We report a case of XGP in a 58 year old woman who presented with abdominal pain, hematuria, and radiating left flank pain. CT scan was felt to be consistent with perirenal hemorrhage abutting a fat-containing renal mass. The patient was eventually taken to surgery for left partial nephrectomy. Pathology report returned as XGP, and the patient has no complications from this disease process at 8 month follow up. Conclusion Our search of the literature shows XGP presenting as SRH to be a rare clinical entity. Furthermore, this is the first such case managed with a nephron-sparing approach. The “great imitator” XGP should be added to the differential for patients presenting with spontaneous renal hemorrhage.
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Affiliation(s)
- William Keith Ballentine
- Department of Urology, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| | | | - Raymond B Dyer
- Department of Radiology, Wake Forest Baptist Health, Winston-Salem, NC, 27157, USA
| | - Majid Mirzazadeh
- Department of Urology, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC, 27157, USA
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Stoica I, O'Kelly F, McDermott MB, Quinn FMJ. Xanthogranulomatous pyelonephritis in a paediatric cohort (1963-2016): Outcomes from a large single-center series. J Pediatr Urol 2018; 14:169.e1-169.e7. [PMID: 29233628 DOI: 10.1016/j.jpurol.2017.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 10/25/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Xanthogranulomatous pyelonephritis (XGP) is an uncommon chronic destructive granulomatous inflammation of the kidney. It was first described in 1916, and is thought to affect 6/1000 cases of pyelonephritis. Its manifestations are varied, and with a limited number of cases in the literature, the optimal diagnosis and management of XGP in the paediatric cohort is still unknown. MATERIAL AND METHODS The medical records of children who were diagnosed and treated for XGP at the current unit during the period 1963-2016, inclusive, were retrospectively reviewed. Information pertaining to each patient was recorded, including: demographic data, past medical history, clinical and biochemical characteristics, diagnostic procedures, treatment methods, histopathologic diagnosis of the removed specimen, and outcome. RESULTS A total of 66 children with a median age of 4.84 years (range 1.1-14.81), with an M:F ratio 1.35:1 underwent nephrectomy for XGP and had a median follow-up of 7.19 years (range 0.11-17.45). The most common presentations were systemic illness (62.1%), pain (60.6%), urinary tract infections (54.5%) and an abdominal mass (39.4%); pyrexia was present in 53%. Biochemical abnormalities included anaemia (86.3%), thrombocytosis (80.3%) and hypomagnesemia (65.1%). There was an 83.3% concordance between intraoperative cultures and positive mid-stream urines. Index kidneys were significantly larger than the contralateral side (mean 1.32 cm; P = 0.002). Staging of XGP demonstrated extension beyond the kidney in 79% of kidneys. Computed tomography (CT) was performed in 11 cases (Summary figure). Dimercaptosuccinic acid (DMSA) scan showed 0-10% function in 90.47% of cases. Surgical procedures included nephrectomy (n = 63) and partial nephrectomy (n = 3). Perioperative complications included colonic resections (n = 5) and abscess formation in 18%. CONCLUSIONS This is the largest series to date of XGP in a paediatric cohort. XGP should be included in the differential diagnosis of all children presenting with perirenal or psoas abscesses, renal masses and/or non-functioning kidneys with/or without associated urolithiasis. Clinical awareness and a high index of suspicion is required to achieve the correct pre-operative diagnosis and appropriate management.
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Affiliation(s)
- I Stoica
- Department of Surgery, Division of Paediatric Urology, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland.
| | - F O'Kelly
- Department of Surgery, Division of Paediatric Urology, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
| | - M B McDermott
- Department of Pathology, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
| | - F M J Quinn
- Department of Surgery, Division of Paediatric Urology, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
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Brosseau S, Gounant V, Choudat L, Pluvy J, Zalcman G, Khalil A. Xanthogranulomatous pyelonephritis complicating crizotinib treatment of an ALK-rearranged non-small-cell lung cancer. Diagn Interv Imaging 2018; 99:267-268. [PMID: 29472032 DOI: 10.1016/j.diii.2018.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 01/13/2018] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
Affiliation(s)
- S Brosseau
- Department of Thoracic Oncology & CIC1425-CLIP2 Paris-Nord, université Paris-Diderot, hôpital Bichat-Claude Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
| | - V Gounant
- Department of Thoracic Oncology & CIC1425-CLIP2 Paris-Nord, université Paris-Diderot, hôpital Bichat-Claude Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - L Choudat
- Department of Pathology, université Paris-Diderot, hôpital Bichat-Claude Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - J Pluvy
- Department of Thoracic Oncology & CIC1425-CLIP2 Paris-Nord, université Paris-Diderot, hôpital Bichat-Claude Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - G Zalcman
- Department of Thoracic Oncology & CIC1425-CLIP2 Paris-Nord, université Paris-Diderot, hôpital Bichat-Claude Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - A Khalil
- Department of Radiology, université Paris-Diderot, hôpital Bichat-Claude Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
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Devrim T, Atasoy P, Tuğlu D. Xanthogranulomatous pyelonephritis: a case with rare adhesion to pancreas. CEN Case Rep 2018; 7:44-7. [PMID: 29177841 DOI: 10.1007/s13730-017-0289-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 11/18/2017] [Indexed: 12/23/2022] Open
Abstract
Xanthogranulomatous pyelonephritis (XGP) is a rare benign condition with unknown aetiology and chronic infection of kidney. Commonly, most cases are related with urinary tract obstruction, nephrolithiasis, infection, diabetes, and/or immune compromise. XGP is associated with destruction of the renal parenchyma and granulomatous inflammation with foamy lipid-laden macrophages resulting from obstructive uropathy. It closely mimics a malignancy, exhibiting local tissue invasion and destruction. Adjacent organs especially duodenum as well as very rarely pancreas or spleen may be involved. Additionally, XGP is known as notorious for fistulisations, such as pyelocutaneous and ureterocutaneous fistulae, which have been reported as well described. XGP may be indistinguishable from renal cell carcinoma by radiographic and clinic consultation so it must be diagnosed based on the histopathologic examinations. Furthermore, macroscopic appearance of XGP is a mass of yellow tissue with focal haemorrhage besides necrosis and in this regard, it grossly resembles renal cell carcinoma. Here, we report the case of a 32-year-old female, preoperatively diagnosed as malignancy by clinical examination. Our further pathological evaluations revealed very rarely adhesion of XGP to pancreas tissue.
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Abstract
Most renal lesions replace the renal parenchyma as a focal space-occupying mass with borders distinguishing the mass from normal parenchyma. However, some renal lesions exhibit interstitial infiltration-a process that permeates the renal parenchyma by using the normal renal architecture for growth. These infiltrative lesions frequently show nonspecific patterns that lead to little or no contour deformity and have ill-defined borders on CT, making detection and diagnosis challenging. The purpose of this pictorial essay is to describe the CT imaging findings of various conditions that may manifest as infiltrative renal lesions.
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Affiliation(s)
- David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - Luis De Alba
- Department of Radiology, Louisiana State University Health Shreveport, 1501 Kings Hwy, Shreveport, LA, 71103, USA
| | - Matias Migliaro
- Department of Radiology, Hospital Santa Isabel de Hungria, 2854 Pedro del Castillo, Guaymallen, 5521, Mendoza, Argentina
| | - Carlos H Previgliano
- Department of Radiology, Louisiana State University Health Shreveport, 1501 Kings Hwy, Shreveport, LA, 71103, USA
| | - Guillermo P Sangster
- Department of Radiology, Louisiana State University Health Shreveport, 1501 Kings Hwy, Shreveport, LA, 71103, USA.
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Sawazaki H, Araki D, Miyata K, Ito K. Massive Renal Replacement Lipomatosis With Foci of Xanthogranulomatous Pyelonephritis in a Horseshoe Kidney. Urol Case Rep 2017; 13:45-47. [PMID: 28443241 PMCID: PMC5397598 DOI: 10.1016/j.eucr.2016.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 10/19/2016] [Indexed: 12/12/2022] Open
Abstract
Renal replacement lipomatosis (RRL) is a rare condition that occurs at the end of the spectrum of renal tissue replacement by fat. Xanthogranulomatous pyelonephritis (XGP) is a granulomatous inflammation characterized by destruction of renal parenchyma and replacement by lipid-laden macrophages. We present the case of a 75-year-old man who complained of severe anemia 34 years after right nephrolithotomy. Computed tomography revealed a huge low-density mass with renal parenchyma atrophy on the right side of horseshoe kidney. Right nephrectomy was performed. Pathological diagnosis was RRL with XGP. This is the first report of RRL with XGP in a horseshoe kidney.
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Affiliation(s)
- Harutake Sawazaki
- Department of Urology, Tama-hokubu Medical Center, Higashimurayama, Japan
| | - Daiji Araki
- Department of Urology, Tama-hokubu Medical Center, Higashimurayama, Japan
| | - Kazunori Miyata
- Department of Urology, Tama-hokubu Medical Center, Higashimurayama, Japan
| | - Keiichi Ito
- Department of Urology, National Defense Medical College, Tokorozawa, Japan
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Chow J, Kabani R, Lithgow K, Sarna MA. Xanthogranulomatous pyelonephritis presenting as acute pleuritic chest pain: a case report. J Med Case Rep 2017; 11:101. [PMID: 28399929 DOI: 10.1186/s13256-017-1277-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 03/23/2017] [Indexed: 11/10/2022] Open
Abstract
Background Xanthogranulomatous pyelonephritis is a rare and serious manifestation of chronic kidney inflammation that can be life-threatening if not recognized and treated appropriately, often with antibiotics and surgery. Affected patients are most commonly females in their fifth or sixth decade of life with a background of obstructive uropathy, nephrolithiasis, or recurrent urinary tract infections who present with vague nonspecific symptoms. Case presentation A 43-year-old woman of Russian ethnicity with a history of nephrolithiasis presented to our emergency department with new left-sided pleuritic chest pain amid a 6-week history of constitutional symptoms including fevers, night sweats, and 7 kg of weight loss. Workup for acute coronary syndrome and pulmonary embolism in our emergency department was negative. Given that she was clinically unwell, she was admitted to internal medicine to expedite workup for the cause of her symptoms. A broad differential diagnosis for various infectious, inflammatory/autoimmune, and neoplastic processes was considered. Based on classic radiographic and histopathologic findings, she was ultimately diagnosed with xanthogranulomatous pyelonephritis of her left kidney, which was a direct consequence of chronic inflammation. This inflammation exhibited spread to local tissues and across her left hemidiaphragm, resulting in a unilateral pleural effusion which explained her chest discomfort. She was treated with antibiotics administered intravenously and urgent total nephrectomy with a good functional outcome. Conclusions Our case illustrates an uncommon but clinically important do-not-miss diagnosis that underlies a common clinical presentation of pleuritic chest pain. The case underscores the importance of maintaining a broad differential diagnosis and organized approach when treating patients with undifferentiated clinical presentations.
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Alazab R, Ghawanmeh HM, Abushamma F, Ababneh O, Al-Karasneh AI. Spontaneous Nephrocutaneous Fistula: Rare Complication of Xanthogranulomatous Pyelonephritis. Urol Case Rep 2017; 11:44-46. [PMID: 28138432 PMCID: PMC5266486 DOI: 10.1016/j.eucr.2016.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 10/19/2016] [Indexed: 12/04/2022] Open
Abstract
Renocutaneous fistulae may occur as a result of chronic infection, especially in the setting of calculous disease.1 Spontaneous renocutaneous is rare.2 Usually nephrocutanous fistula developed in patient with previous renal surgery, trauma, tumors, and chronic urinary tract infection with abscess formation. We report a case of spontaneous nephrocutaneous fistula. A 37-year-old women previously well presented to ER department with purulent discharge and a palpable mass on the left lumbar area. CT scan with IV contrast fistulous tract seen within the subcutaneous plane in Left lumbar region tracking towards retroperitoneal space, and in continuity with of left kidney. The patient underwent ‘Left nephrectomy with excision of fistulous tract’ after long course of antibiotics.
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Affiliation(s)
- Rami Alazab
- Department of Urology and General Surgery, Jordan University of Science and Technology, Irbid, Jordan
| | - Hamzeh M Ghawanmeh
- Department of Urology and General Surgery, Jordan University of Science and Technology, Irbid, Jordan; King Abdullah University Hospital, Irbid, Jordan
| | - Faris Abushamma
- Department of Urology and General Surgery, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar Ababneh
- Department of Urology and General Surgery, Jordan University of Science and Technology, Irbid, Jordan
| | - Anas I Al-Karasneh
- Department of Urology and General Surgery, Jordan University of Science and Technology, Irbid, Jordan
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Shimbori M, Nakaigawa N, Yokomizo Y, Kasahara R, Sato M, Hasumi H, Hayashi N, Makiyama K, Kondo K, Umeda S, Yao M. [A CASE OF XANTHOGRANULOMATOUS PYELONEPHRITIS ASSOCIATED WITH CHROMOPHOBE RENAL CELL CARCINOMA]. Nihon Hinyokika Gakkai Zasshi 2017; 108:154-7. [PMID: 30033979 DOI: 10.5980/jpnjurol.108.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Xanthogranulomatous pyelonephritis (XGP) is a type of chronic suppurative renal inflammation. We present an extremely rare case of XGP concomitant with chromophobe renal cell carcinoma (RCC). A-39-year-old woman presented with transient fever and left lower abdominal pain during steroid pulse therapy for thyroid eye disease. Imaging studies including contrast-enhanced computed tomography, magnetic resonance imaging, and doppler ultrasonography, showed a 40 mm unusual mass lesion in the upper pole of the left kidney, and we could not rule out the possibility of malignancy.A left open partial nephrectomy for the renal mass was performed. Pathological examination revealed a 5 mm chromophobe RCC located beside a 30 mm XGP. The patient presented a favorable course without inflammatory episodes or tumor recurrence during the 9-month follow-up. This is the first case report of the coexistent XGP and chromophobe RCC.
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Abstract
Background Xanthogranulomatous pyelonephritis (XGP) is a rare renal tumor that arises as a complication of chronic obstructive pyelonephritis of uncertain etiology. It is primarily an adult tumor seen occasionally in children associated with urinary tract obstruction due to congenital urological anomalies, nephrolithiasis, and recurrent urinary tract infections. Radiologically, it may show neoplastic features such as those seen in common pediatric renal malignancies like wilms’ tumor and renal cell carcinoma. This overlap in radiological manifestation frequently leads to misdiagnosis and delay in appropriate intervention. We report a case of a 3 years old boy who presented with history of recurrent urinary tract infections and a left renal mass initially thought to be Wilms’ tumor. Case presentation We present a case of a 3 years old boy admitted to the Pediatric oncology unit at Muhimbli National Hospital in Dar es Salaam, Tanzania with one year history of recurrent fever and urinary tract infection signs and symptoms refractory to antibiotic therapy. He was eventually found to have a left kidney mass detected at the District hospital by abdominal ultrasound performed to evaluate a flank mass that was felt by his mother. He was then referred to our unit for a suspicion of Wilms’ tumor which finally turned out to be a left kidney Xanthogranulomatous pyelonephritis. He underwent a successful left nephrectomy and was discharged from hospital in a stable clinical condition and remains asymptomatic at the time of submission of this case report. Conclusion This case report underscores the need for clinicians attending a febrile child with a renal mass that can be confused with common pediatric renal malignancies such as Wilms’ tumor to broaden their differential diagnosis. The case also underlines the significance of individualized patient evaluation because this patient would have otherwise received preoperative chemotherapy under the International Society of Pediatric Oncology (SIOP) guidelines if the diagnosis of Wilms tumor was not ruled out.
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Affiliation(s)
- Shakilu Iumanne
- Muhimbili University of health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania. .,College of Health Sciences, University of Dodoma, Box 339, Dodoma, Tanzania.
| | - Aika Shoo
- Muhimbli National Hospital, P.O. Box 65000, Dar es Salaam, Tanzania
| | - Larry Akoko
- Muhimbili University of health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Patricia Scanlan
- Muhimbli National Hospital, P.O. Box 65000, Dar es Salaam, Tanzania
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Khoo HW, Lee CH. Renal squamous cell carcinoma mimicking xanthogranulomatous pyelonephritis: Case report and review of literature. Radiol Case Rep 2016; 11:74-7. [PMID: 27257454 PMCID: PMC4878933 DOI: 10.1016/j.radcr.2016.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/28/2016] [Indexed: 10/27/2022] Open
Abstract
Primary renal squamous cell carcinoma (SCC) is a rare primary malignancy of the kidney. Diagnosis is usually delayed because of its lack of characteristic clinical and imaging features and inherent aggressive nature. We present a case of primary renal SCC in a 66-year-old woman with bilateral renal calculi and a complex right lower pole renal mass. The diagnosis of primary renal SCC was established based on the histopathology after right nephrectomy.
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Affiliation(s)
- Hau Wei Khoo
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, 11, Jalan Tan Tock Seng, Singapore 308433
| | - Chau Hung Lee
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, 11, Jalan Tan Tock Seng, Singapore 308433
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Friedl A, Tuerk C, Schima W, Broessner C. Xanthogranulomatous Pyelonephritis with Staghorn Calculus, Acute Gangrenous Appendicitis and Enterocolitis: A Multidisciplinary Challenge of Kidney-Preserving Conservative Therapy. Curr Urol 2016; 8:162-5. [PMID: 26889137 DOI: 10.1159/000365709] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 10/24/2014] [Indexed: 11/19/2022] Open
Abstract
Xanthogranulomatous pyelonephritis (XP) is a rare form of pyelonephritis and without treatment destructive to the kidney. We describe a 74-year-old Caucasian immunocompetent female patient with XP and multiple abscesses on the upper pole of the right kidney and several impacted obstructing renal calculi in the middle calyx that developed severe colitis and gangrenous appendicitis during therapy. Proteus mirabilis was detected as the major pathogen in the urine culture. Kidney preserving therapy was carried out by intensive parenteral bacterial eradication, CT-guided abscess drainage and stone destruction by 3 sessions of extracorporeal shock wave lithotripsy under ureteral stenting. Large tumor masses in XP are often daunting and may lead to a nephrectomy. However, kidney-preserving therapy is possible and should be considered in non-septic patients or in case of a solitary kidney.
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Affiliation(s)
| | - Christian Tuerk
- Department of Urology/Stone Center, Rudolfstiftung Hospital Vienna, Austria
| | - Wolfgang Schima
- Department of Diagnostic and Interventional Radiology, Hospital Göttlicher Heiland; Vienna, Austria
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Nachiappan M, Litake MM, Paravatraj VG, Sharma N, Narasimhan A. Squamous Cell Carcinoma of the Renal Pelvis, A Rare Site for a Commonly Known Malignancy. J Clin Diagn Res 2016; 10:PD04-6. [PMID: 26894122 DOI: 10.7860/jcdr/2016/17846.7081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 12/03/2015] [Indexed: 11/24/2022]
Abstract
Chronic nephrolithiasis predisposes to squamous metaplasia and subsequently SCC which is a rare malignancy of the upper urinary tract. A 60-year-old woman with a long standing history of renal calculi presented with flank pain and fever. Investigations revealed a mass in the superior pole of a non functioning left kidney while the right kidney was sub optimally functioning, hydronephrotic and there was presence of bilateral staghorn calculi. Patient underwent decompression of right kidney by double j stenting and left radical nephrectomy that revealed well differentiated squamous cell carcinoma of renal pelvis. Most SCC of the renal pelvis present with advanced disease and dismal prognosis while our patient presented with localized disease without lymphatic and distant metastasis. Thus radical nephrectomy can be curative if the disease can be diagnosed at an earlier stage. This emphasizes the need of early treatment of nephrolithiasis to prevent the development of SCC and screening of patients with long standing staghorn calculi.
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Affiliation(s)
- Murugappan Nachiappan
- Assistant Professor, Department of Surgery, BJGMC and Sassoon General Hospitals , Pune, India
| | | | | | - Navil Sharma
- Junior Resident, Department of Surgery, BJGMC and Sassoon General Hospitals , Pune, India
| | - Aditya Narasimhan
- Junior Resident, Department of Surgery, BJGMC and Sassoon General Hospitals , Pune, India
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Abstract
This review discusses the pathology of non-neoplastic kidney disease that pathologists may encounter as nephrectomy specimens. The spectrum of pediatric disease is emphasized. Histopathologic assessment of non-neoplastic nephrectomy specimens must be interpreted in the clinical context for accurate diagnosis. Although molecular pathology is not the primary focus of this review, the genetics underlying several of these diseases are also touched on.
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Affiliation(s)
- Joseph P Gaut
- Nephropathology Associates, 10810 Executive Center Drive, Suite 100, Little Rock, AR 72211, USA.
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44
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Abstract
This review discusses the various gross and histologic findings seen in renal infections due to bacteria, viruses, fungi, and mycobacteria. It is crucially important to separate infectious processes in the kidney from other inflammatory or neoplastic processes, as this will have a major impact on therapy. We describe the diagnostic features of renal infections with a specific focus on the differential diagnosis and other processes that may mimic infection. The topics discussed include acute bacterial pyelonephritis, chronic bacterial pyelonephritis, xanthogranulomatous pyelonephritis, malacoplakia, viral infections in the kidney, fungal pyelonephritis and mycobacterial infection of the kidney.
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Affiliation(s)
- Jean Hou
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York Presbyterian Hospital, VC14-224, New York, NY 10032, USA
| | - Leal C Herlitz
- Division of Renal Pathology, Department of Pathology and Cell Biology, Columbia University Medical Center, New York Presbyterian Hospital, VC14-224, New York, NY 10032, USA.
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Butticè S, Antonino I, Giorgio A, Valeria B, Stefano P, Giuseppe M, Carlo M. Xanthogranulomatous Pyelonephritis Can Simulate a Complex Cyst: Case Description and Review of Literature. Urol Case Rep 2014; 2:113-5. [PMID: 26955560 PMCID: PMC4733033 DOI: 10.1016/j.eucr.2014.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 03/31/2014] [Indexed: 11/25/2022] Open
Abstract
Xanthogranulomatous pyelonephritis is a rare and peculiar form of chronic pyelonephritis and is generally associated with renal lithiasis. Its incidence is higher in females. The peculiarity of this disease is that it requires a differential diagnosis, because it can often simulate dramatic pathologic conditions. In fact, in the literature are also described cases in association with squamous cell carcinoma of the kidney The radiologic clinical findings simulate renal masses, sometimes in association with caval thrombus. We describe a case of xanthogranulomatous pyelonephritis with radiologic aspects of a complex cyst of Bosniak class III in a man 40-year old.
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Affiliation(s)
- Salvatore Butticè
- Unit of Urology, Department of Human Pathology, University of Messina, Italy
| | - Inferrera Antonino
- Unit of Urology, Department of Human Pathology, University of Messina, Italy
| | - Ascenti Giorgio
- Department of Radiological Sciences, University of Messina, Italy
| | - Barresi Valeria
- Unit of Pathological Anatomy, Department of Human Pathology, University of Messina, Italy
| | | | - Mucciardi Giuseppe
- Unit of Urology, Department of Human Pathology, University of Messina, Italy
| | - Magno Carlo
- Unit of Urology, Department of Human Pathology, University of Messina, Italy
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Abstract
BACKGROUND To retrospectively determine key demographic and clinical features of 35 patients with Xanthogranulomatous pyelonephritis (XGP) in a New Zealand setting and to compare it with the existing literature. METHODS A retrospective review of patients having a confirmed diagnosis of XGP on histopathology examination was performed. Key clinical and demographic features were analysed and compared with the published literature. RESULTS XGP was diagnosed in 35 patients over a 12-year (2001-2013) period in Auckland Public Hospital. Ninety-one percent of the patients were female. The population had significantly higher numbers of Maori and Pacific Island patients compared with the general population (74%). Staghorn calculi were the most common cause (51.4%) with obstructing ureteric calculi as the next most common (22.9%) cause. Twenty percent of cases were not thought to be XGP prior to nephrectomy (suspicious renal mass). Thirteen (38%) patients suffered serious complications post-operatively (Clavien 3-5). CONCLUSION XGP is a rare chronic inflammatory condition that appears to be overrepresented by Maori and Pacific islanders in our cohort when compared with the overall patient pool. Surgical treatment is associated with significant morbidity but remains the only definitive option. Obesity and other conditions associated with metabolic syndrome may coexist at the time of presentation and may be contributing factors to the development of XGP and poor outcomes associated with it.
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Affiliation(s)
- Ben Addison
- Department of General Surgery, North Shore Hospital, Auckland, New Zealand
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Abstract
CONTEXT Xanthogranulomatous pyelonephritis is an extremely rare but known entity resulting from prolonged suppuration of the kidney. The disease may be focal or diffuse and may pose considerable diagnostic dilemma at times. Surgery is curable and remains optimal treatment of choice. Owing to its rarity and clinical curiosity we report such a rare case encountered in our clinical practice. CASE REPORT We report a case of non-functioning kidney suggestive of either Tuberculosis or xanthogranulomatous pyelonephritis in the pre-operative period depending upon the clinical aqumen and investigations available and nephrectomy was done. It was confirmed as xanthogranulomatous pyelonephritis histopathologically. CONCLUSION Preoperative diagnosis of xanthogranulomatous pyelonephritis may pose difficulty and nephrectomy remains the treatment of choice especially in diffuse cases of xanthogranulomatous pyelonephritis.
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Affiliation(s)
- Subhash Goyal
- Department of Surgery, M.M. Institute Of Medical Sciences And Research, Mullana (Distt - Ambala), Haryana, India, PIN:133203
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Rajesh A, Jakanani G, Mayer N, Mulcahy K. Computed tomography findings in xanthogranulomatous pyelonephritis. J Clin Imaging Sci 2011; 1:45. [PMID: 22315712 PMCID: PMC3272912 DOI: 10.4103/2156-7514.84323] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 08/01/2011] [Indexed: 11/05/2022] Open
Abstract
Background: Xanthogranulomatous pyelonephritis (XGN) is an uncommon condition characterized by chronic suppurative renal inflammation that leads to progressive parenchymal destruction. Purpose: To review the computed tomography (CT) findings of patients diagnosed with XGN. Materials and Methods: A retrospective review of CT findings in patients with histologically proven XGN was carried out. Results: Thirteen CT examinations of 11 patients were analyzed. Renal enlargement was demonstrable on the affected side in all patients. Nine patients (82%) had multiple dilated calyces and abnormal parenchyma. Six patients (55%) had a renal pelvis or upper ureteric calculus causing obstruction. Three patients (27%) had focal fat deposits identifiable within the inflamed renal parenchyma. Two patients had renal abscesses. Ten patients (91%) had extrarenal extension of the inflammatory changes. Three patients (27%) demonstrated extensive retroperitoneal inflammation. Conclusion: Unilateral renal enlargement and inflammation were the most consistent findings of XGN on CT. Perinephric inflammation and collections or abscess should also alert the radiologist to the possibility of this diagnosis.
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Affiliation(s)
- Arumugam Rajesh
- Department of Clinical Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, United Kingdom
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Abstract
BACKGROUND This study was carried out to assess the spectrum of renal and perinephric space infection among urology patients admitted in the last three years. METHODS Medical records of patients with renal and perinephric abscess and emphysematous pyelonephritis were reviewed. RESULTS Out of 2278 patients admitted in last three years, 29 (1.2%) patients suffered from renal and perinephric space infection, 13 (45%) patients had renal abscess, 11 (38%) perinephric abscess and five (17%) emphysematous pyelonephritis. Sixteen (55%) patients recovered conservatively, nine (31%) patients required percutaneous drainage of the abscesses and remaining four (14%) underwent surgical exploration. The overall mortality was 14% in this study. CONCLUSION Renal and perinephric space infection continues to be a serious urological problem with high mortality rate. A high index of suspicion, prompt diagnosis, appropriate antibiotics and surgical intervention may be effective in reducing mortality.
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