Xanthogranulomatous pyelonephritis in a pediatric patient

Abstract

Introduction: Xanthogranulomatous pyelonephritis consists of a chronic infectious and inflammatory process of the renal parenchyma, a variant of chronic obstructive pyelonephritis. It is more prevalent in middle-aged adults, rare in pediatric patients, with less than 300 cases reported in children worldwide. Report: Preschooler, aged 2 years and 11 months, male, with 2 months of abdominal distention, increased temperature and intense pallor, associated with microcytic anemia refractory to the use of ferrous sulfate. 1 week before, he had a bulging in his left flank and a hard palpable mass there. Imaging exams (ultrasound and tomography) revealed an overall enlargement of the left kidney, destruction of the renal parenchyma and intense calyceal dilation, forming the "bear's paw" sign, with a staghorn calculus in the pelvis. He underwent treatment with antibiotic therapy and total nephrectomy, with a specimen sent for pathological examination. Discussion: a disease of uncertain incidence in the pediatric age group, xanthogranulomatous pyelonephritis is more prevalent in male children and affects mainly the left kidney, being frequently associated with the presence of stones. Clinically, it has nonspecific symptoms, the most common being abdominal distension and asthenia. Laboratory exams shows microcytic, leukocytosis, thrombocytosis and increased inflammation, pyuria, hematuria and proteinuria, in addition to bacterial growth in urine culture. The diagnosis is anatomopathological, but it can be hinted by contrasted CT scan, with the classical sign of the "bear's paw". Treatment may include nephrectomy and broad-spectrum antibiotic therapy.

Epilogue: Anaemia + abdominal mass = is it cancer?

“…XGP is an uncommon presentation in children and incorporates less than 1% of chronic pyelonephritis 2 3. It involves a chronic suppurative process of unknown pathogenesis that leads to destruction of renal parenchyma and replacement with granulomatous tissue, leading to a non-functional kidney4 (figure 4).…”

“…It involves a chronic suppurative process of unknown pathogenesis that leads to destruction of renal parenchyma and replacement with granulomatous tissue, leading to a non-functional kidney4 (figure 4). Clinical presentation is non-specific and often includes abdominal distension, abdominal pain, fever, malaise and anorexia 2 3 5. Laboratory investigations often show raised inflammatory markers, anaemia, thrombocytopenia, but normal renal function if the opposite kidney is unaffected.…”

“…D—Xanthogranulomatous pyelonephritis (XGP). The MRI scan shows the classical ‘bear paw’ sign pathognomonic of XGP1 2 (figure 3).…”

Xanthogranulomatous pyelonephritis in neonate: presentation, management and outcome

“…It is most common among women of age 40–60 years and is seen only sporadically in children with just less than 300 cases reported worldwide to date 1. The age of onset varies (21 days to 16 years), although 60%–75% of cases have been diagnosed before 5 years of age 2. Neonatal cases are exceptionally rare, with only two cases reported in the literature 3 4.…”