Emphysematous and xanthogranulomatous pyelonephritis: rare diagnosis

Ramos, Lya Duarte; Lima, Marinus de Moraes; Carvalho, Maurício; Júnior, Geraldo Bezerra da Silva; Daher, Elizabeth De Francesco

doi:10.1590/s1413-86702010000400011

Cited by 5 publications

(9 citation statements)

References 7 publications

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“…Its diagnosis is histopathological. Therefore, it must be histologically differentiated from two similar inflammatory conditions: renal parenchymal malakoplakia and megalocytic interstitial nephritis [8]. In the case of our patient, renal TB was excluded from the possible diagnoses because of his demographic characteristics, personal background, clinico-radiological findings, and natural history of the disease.…”

Section: Discussionmentioning

confidence: 96%

“…In contrast, in malakoplakia, their sighting is not mandatory for a diagnosis, nor are they required to develop the disease. Xanthogranulomatous pyelonephritis is associated with renal calculi in approximately 80% of the cases, according to some studies [8,9]. Consequently, the only proper way both pathologies could be differentiated would be through a histopathological analysis where malakoplakia presents von Hansemann cells (eosinophilic histiocytes) and Michaelis-Gutmann bodies (intracytoplasmic basophilic inclusions).…”

Section: Symptoms Differential Diagnosesmentioning

confidence: 99%

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Xanthogranulomatous Pyelonephritis and Its Differential Diagnoses: An In-Depth Case Review

Herrera-Bedoya¹,

Capriles²,

Zakzuk-Martinez³

et al. 2021

Cureus

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Section: Discussionmentioning

confidence: 96%

Section: Symptoms Differential Diagnosesmentioning

confidence: 99%

Xanthogranulomatous Pyelonephritis and Its Differential Diagnoses: An In-Depth Case Review

Herrera-Bedoya¹,

Capriles²,

Zakzuk-Martinez³

et al. 2021

Cureus

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“…Ramos et al [18] stated that the diagnosis of pyelonephritis tends to be easy to establish with regard to the majority of cases; however, there are unusual presentations of pyelonephritis that make its diagnosis difficult to establish. Ramos et al [18] reported a case of Xanthogranulomtous pyelonephritis as follows:…”

Section: Kuo Et Al [7] Made the Ensuing Conclusionmentioning

confidence: 99%

“…She was continued on antibiotics and she steadily improved symptomatically. Ramos et al [18] [31].  With regard to treatment, the gold standard treatment for xanthogranulomatous pyelonephritis and emphysematous pyelonephritis does entail nephrectomy which also tends to be total nephrectomy with regard to the majority of cases and during the operation it would be important to remove circum-adjacent inflammatory tissues.…”

Section: Kuo Et Al [7] Made the Ensuing Conclusionmentioning

confidence: 99%

Xanthogranulomatous Pyelonephritis A Review and Update of the Literature

Venyo

2019

Int Res in Med and Heal Sci

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Xanthogranulomatous pyelonephritis (XGP) is a rare chronic destructive granulomatous inflammatory process that affects sporadically the parenchyma of the kidney and the disease tends to be associated in many cases with long-term urinary tract obstruction, urinary tract infection and also in cases with calculi within the kidney. XGP does affect females more commonly in comparison with males, it does affect all age groups including newly born up to the elderly. Majority of the patients tend to be symptomatic and some of the symptoms could include: pyrexia, flank / loin / abdominal pain, palpable mass in loin/abdomen/costovertebral region, weight loss, visible haematuria. There may be associated diabetes mellitus, obesity, or immune deficiency. There may be anaemia and leucocytosis upon blood tests. Urine cultures may grow Escherichia coli, or proteus but in other situations the urine culture could be negative. Ultrasound scan of renal tract, CT and MRI scan of abdomen and pelvis tend to be undertaken in the assessments of patients. CT scan has globally been the establishment of radiology imaging diagnosis. Radiology imaging may demonstrate focal or diffuse XGP but the diffuse form is more common. It may reveal multiple lowattenuated cystic masses in the kidney, calculi in the kidney, hydronephrosis / dilated calyces / bear's paw appearance in some cases. Macroscopy examination of the specimen of the kidney would tend to show multiple yellow nodules around calyces, and the lesion may form a mass or be infiltrative. Pathology examination of specimens of XGP would tend to show granulomatous inflammatory infiltrate that consists of neutrophils, lymphocytes, plasma cells, xanthomatous histiocytes, as well as multi-nucleated giant cells. Immunohistochemistry staining may show positive staining for CD68. Some of the differential diagnoses include: clear cell carcinoma of the kidney, papillary renal cell carcinoma, sarcomatoid renal cell carcinoma, leiomyosarcoma, malakoplakia of kidney, megalocystic interstitial nephritis, and renal replacement lipomatosis. Majority of diffuse cases have been treated by nephrectomy and antibiotics and some focal cases have been treated by partial nephrectomy and antibiotics but on very rare occasions cases have been treated by drainage of the abscess with biopsy and in conjunction with antibiotics. Percutaneous nephrostomy has also been undertaken pre-operatively to decompress the kidney by draining the abscess in the occasional case.

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“…His full blood count showed white blood cell 21.6 x10 3 /μL, haemoglobin 6.9 g/dL and platelet count 136 × 10 3 /μL. It is possible that the leukocytosis could be a consequence of the haemolytic crisis itself [12]. Despite ceftriaxone therapy, the patient remained febrile with a leucocytosis at day three of admission.…”

Section: Case Presentationmentioning

confidence: 99%

The reality of using primaquine

Burgoine

Bancone

Nosten

2010

Malar J

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BackgroundPrimaquine is currently the only medication used for radical cure of Plasmodium vivax infection. Unfortunately, its use is not without risk. Patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency have an increased susceptibility to haemolysis when given primaquine. This potentially fatal clinical syndrome can be avoided if patients are tested for G6PD deficiency and adequately informed before being treated.Case presentationA 35-year old male presented to our clinic on the Thai-Burmese border with a history and clinical examination consistent with intravascular haemolysis. The patient had been prescribed primaquine and chloroquine four days earlier for a P. vivax infection. The medication instructions had not been given in a language understood by the patient and he had not been tested for G6PD deficiency. The patient was not only G6PD deficient but misunderstood the instructions and took all his primaquine tablets together. With appropriate treatment the patient recovered and was discharged home a week later.ConclusionsWhilst primaquine remains the drug of choice to eradicate hypnozoites and control P. vivax transmission, the risks associated with its use must be minimized during its deployment. In areas where P. vivax exists, patients should be tested for G6PD deficiency and adequately informed before administration of primaquine.

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Emphysematous and xanthogranulomatous pyelonephritis: rare diagnosis

Cited by 5 publications

References 7 publications

Xanthogranulomatous Pyelonephritis and Its Differential Diagnoses: An In-Depth Case Review

Xanthogranulomatous Pyelonephritis and Its Differential Diagnoses: An In-Depth Case Review

Xanthogranulomatous Pyelonephritis A Review and Update of the Literature

The reality of using primaquine

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