Nephron-sparing management of Xanthogranulomatous pyelonephritis presenting as spontaneous renal hemorrhage: a case report and literature review

Abstract

BackgroundXanthogranulomatous 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 presentationWe 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.ConclusionOur 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.

Nontraumatic spontaneous bilateral renal hemorrhages (Wünderlich syndrome) with chronic infection of Chlamydia pneumoniae: A case report

“…Chronic infection has been also recognized as a risk factor for organ hemorrhage based on the crossreactivity of the pathogen antigen and the infection-induced immune responses. [16][17] A case report that revealed a signi cant correlation between SAH and seropositivity for IgG/IgA antibodies against Chlamydia pneumoniae implied that subsequent infection of Chlamydia pneumoniae could be one of the risk factors for SAH from ruptured intracranial aneurysm. 17 Additionally, several studies have reported that Chlamydia pneumoniae infection is closely associated with acute exacerbation of chronic lung diseases, such as bronchial asthma, DPB, and COPD.…”

Xanthogranulomatous pyelonephritis: a focus on microbiological and antibiotic resistance profiles

“…CT accurately defined the extent of the perinephric inflammatory reaction [ 14 ]. According to Malek and Elder’s radiological classification, XGP can be subdivided into 3 stages on the basis of the extent of involvement of the adjacent tissue [ 15 ]: stage I, nephric disease confined to the kidney; stage II, infiltration into the Gerota fascia; and stage III, disease extending into adjacent perinephric space and other retroperitoneal structures (Fig. 2 ) [ 16 ].…”

Wunderlich syndrome (spontaneous renal hematoma) as a cause of acute abdomen: a case report

“…14 In centers with low availability of minimal invasion approaches, in patients with focal lesions or complications as perirrenal abscess, radical or partial nephrectomy are the options to consider. 15 Image guided percutaneous drainage has been reported as a minimal invasion approach for treatment, but it hasn't been formally studied. 16 In the practice, there is no clinical guideline for SRH management, partially because of its low incidence; nevertheless classifications and management of traumatic renal hematoma can be used.…”