Focal xanthogranulomatous pyelonephritis simulating malignancy in children

Abstract

Xantogranulomatous pyelonephritis is a severe chronic form of renal parenquimal infection that usually results in diffuse renal destruction. An unusual case of xanthogranulomatous pyelonephritis in a child is reported which presented as a focal mass without calculus in a functioning kidney and was diagnosed as a renal tumor.

Xanthogranulomatous pyelonephritis in an eight year old male child: A case report and review of the literature

“…It is a severe and atypical form of chronic inflammatory condition of the kidney that is increasingly well recognized [ 1 ]. The disease process is characterized by the destruction and replacement of renal parenchyma by lipid-laden macrophages (xanthoma cells), [ [1] , [2] , [3] ]. Like it was the case in our patient, XP is generally associated with urinary tract infection and obstructing renal calculi, leading to diffuse or focal kidney destruction [ 3 ].…”

“…XP mainly occurs in adults with preponderance in females of younger age group [ 8 ]. It is usually associated with renal stones in nearly 2/3 of cases and concomitant infection with E. coli , Proteus mirabilis , Klebsiella spp , Staphylococcus aureus , Enterococcus spp , Pseudomonas spp , Streptococcus spp , including anaerobic organisms [ 2 , 10 ]. Bilateral lesions although rare, have a fatal outcome [ 8 ].…”

“…Xanthogranulomatous pyelonephritis (XP) is a rare and severe variant of chronic pyelonephritis constituting less than 1% of chronic pyelonephritis [ 1 ]. It is frequently associated with urinary tract obstruction or nephrolithiasis [ 2 ]. Pre-operatively, it may mimic renal tuberculosis or renal carcinoma due to its vague clinical presentation, equivocal laboratory and radiological investigations [ [1] , [2] , [3] ].…”

“…It is frequently associated with urinary tract obstruction or nephrolithiasis [ 2 ]. Pre-operatively, it may mimic renal tuberculosis or renal carcinoma due to its vague clinical presentation, equivocal laboratory and radiological investigations [ [1] , [2] , [3] ]. The confirmatory diagnosis of this entity is based on histopathological examination and surgery remains the treatment of choice in almost all cases.…”

Case 17-2000

“…12,13 Many children present with evidence of chronic illness, including anemia and failure to thrive. Since xanthogranulomatous pyelonephritis is often initially thought to be a neoplasm, [14][15][16][17] nephrectomy has been the usual treatment. With the identification of more specific diagnostic criteria, however, there have been isolated reports of partial nephrectomy or even nonsurgical therapy for xanthogranulomatous pyelonephritis.…”