Xanthogranulomatous Pyelonephritis in Childhood: Presenting as a Subcutaneous Mass: Two Cases

Klafkowski, Gillian; Abernethy, Laurence; Pilling, David

doi:10.1053/crae.2002.0008

Cited by 2 publications

(2 citation statements)

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“…XPN presents with clinical manifestations such as fever, abdominal pain, localized flank pain, pyrexia, microscopic and macroscopic hematuria, pyuria, weight loss, and tender renal mass 3,4 . Our patient was also referred with complaints of abdominal pain, hyperpyrexia, and abdominal distension.…”

Section: Discussionmentioning

confidence: 81%

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Complicated xanthogranulomatous pyelonephritis in a child

Özkayın¹,

İnan²,

Aladağ³

et al. 2010

Pediatrics International

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Key words child, staghorn stone, xanthogranulomatous pyelonephritis.Xanthogranulomatous pyelonephritis (XPN) is a severe and atypical form of chronic renal parenchymal infection. 1 Its clinical manifestations mimic neoplastic and other inflammatory diseases. XPN is seen more frequently in women. It is rare during pediatric ages and peaks in the sixth and seventh decades. 2, 3 We report an unusual case of complicated XPN in a boy and discuss its clinical features, histopathological findings and surgical treatment. Case reportA five-year-old boy with complaints of intermittent abdominal pain, concomitant hyperpyrexia, and the additional symptoms of abdominal distention and loss of appetite was referred to our clinic. His history revealed that his growth and development were uneventful. Familial history of renal calculi, renal disease and tuberculosis was not identified.His physical examination findings were as follows: weight, 15 kg (10-25 percentiles); height, 102 cm (10-25 percentiles); heartbeat, 124/min; respiratory rate, 22/min; blood pressure, 90/50 mmHg (<90 p). A bacillus Calmette-Guérin vaccination scar was not noted. A pansystolic murmur at a severity of 2/6 degrees was auscultated on all cardiac foci. The abdomen was distended. A mass on the left side extending beyond the midline into the pelvis with dimensions of 8 ¥ 10 cm was palpated. Bilateral costovertebral angle tenderness was detected. Physical examination of other systems was unremarkable.His laboratory findings were as follows: white blood cell count, 15 400/mm 3 ; hemoglobin, 6.9 g/dL; mean corpuscular volume, 54 f/L; mean corpuscular hemoglobin, 16 pg; red cell distribution width, 20.5%; platelets, 318 000/mm 3 . Peripheral blood smear findings revealed polymorphonuclear leucocytes (76%), clubbed forms (6%), lymphocytes, toxic granulation, and hypochromia (18%). Acute phase reactants such as erythrocyte sedimentation rate (140 mm/s), and C-reactive protein (86.3 mg/L) were also measured. Biochemical values were within normal limits. Urine analysis showed: urine density, 1015; pH, 6; leukocytosis, and leukocyte clusters. Urine culture was obtained and antibiotherapy was initiated. Urine culture was unremarkable.In an abdominal ultrasonography, the left kidney was enlarged diffusely (127 ¥ 61 mm). A staghorn stone within the left renal pelvis measuring 21 mm, and a few millimetric calculi within all of the calyceal groups were detected. The pelvic-calyceal system appeared dilated. Abdominal computed tomography (CT) was consistent with left renal pelviceal stone, diffuse enlargement, air image in the parenchyma and hydro-pyonephrosis (Fig. 1). In a technetium 99m-dimercaptosuccinic acid renal scan a nonfunctional left kidney was revealed. In a technetium 99m-diethylene terapentaacetic acid renal scan an obstructive pattern in the left kidney refractory to diuretics was observed.At this stage, a total nephrectomy was performed with a lumbotomy incision. During the operation, the perinephric area was fibrotic and the dissection of the kidney was do...

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Section: Discussionmentioning

confidence: 81%

“…XPN is seen more frequently in women. It is rare during pediatric ages and peaks in the sixth and seventh decades 2,3 . We report an unusual case of complicated XPN in a boy and discuss its clinical features, histopathological findings and surgical treatment.…”

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confidence: 93%