Tomographic aspects of xanthogranulomatous pyelonephritis and related complications

Abstract

The authors present their experience involving seven patients with histopathologic diagnosis of xanthogranulomatous pyelonephritis who were submitted to preoperative computed tomography (CT). The results are the following: a) stones (86 percent of the cases), b) increase in renal volume, c) hydronephrosis, d) density measurements (from 14 to 29 HU), e) enhancement found in all cases, f) extrarenal involvement (all cases). CT has shown to be a reliable method in characterizing xanthogranulomatous xyelonephritis and extrarenal involvement.

Renal Replacement Lipomatosis with Psoas Abscess Mimicking as Xanthogranulomatous Pyelonephritis

“…Renal replacement lipomatosis and xanthogranulomatous pyelonephritis may mimic each other as well as can coexist in same patient and are difficult to differentiate at times due to common etiological factors like chronic inflammation and renal calculus. Renal replacement lipomatosis shows increased adipose tissue content in renal sinus and perirenal tissues with formation of reniform lipomatous mass lesion while xanthogranulomatous pyelonephritis is characterized by infiltration of lipid-loaded inflammatory foam cells in the renal parenchyma [6]. On CT imaging xanthogranulomatous pyelonephritis shows presence of multiple hypodense lesions in renal parenchyma suggesting abscesses with renal stones, infected hydronephrosis and involvement of surrounding soft tissue or abdominal wall without much evidence of proliferated fat in and around the kidney [7].…”

Renal replacement lipomatosis - A rare but also underdiagnosed entity

“…13 Patient may be asymptomatic and can show various features, the usual complaint in literature is flank pain, dull aching, and non-radiating, weight loss, hematuria, fever and palpable mass, some of which were seen in these cases. 1,2,4,14,15 They can also present with complaints of urinary tract infections due to urinary stones or mass in the abdominal cavity. 3 Blood urea nitrogen and serum creatinine is usually within the normal limits 4 .…”

Emphysematous and xanthogranulomatous pyelonephritis: rare diagnosis

“…In 1935, it was named xanthogranulomatous pyelonephritis by Oberling. 6,7 Xanthogranulomatous pyelonephritis is characterized by a chronic infl ammatory process, with destruction of renal parenchyma, subsequently replaced by a granulomatous tissue, containing mononuclear macrophages and lipids (Xanthomam Cells). 8,9 This clinical entity represents 1% of all renal infections.…”

“…In rare cases, partial nephrectomy can be successfully performed. 2,4,6,8,12,13,16 Nephrostomy before nephrectomy can be considered a method that facilitates surgery, because it allows a reduction in renal mass and favors the access to the kidney at the time nephrectomy is done. 2,5,12 Antibiotics alone are not effective for these infections, but should be initiated before surgical procedure in order to control the infectious process and avoid systemic involvement (sepsis).…”