Xanthogranulomatous Pyelonephritis in Children: Diagnostic and Therapeutic Aspects

Bingöl-Koloğlu, Meltem; Çiftçi, Arbay Ö.; Şenocak, Mehmet Emìn; Tanyel, Feridun Cahit; Karnak, İbrahìm; Büyükpamukçu, Nebìl

doi:10.1055/s-2002-25085

Cited by 57 publications

(92 citation statements)

References 19 publications

(102 reference statements)

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“…They recommend preliminary drainage, either surgically or percutaneously, of extrarenal abscesses prior to definitive surgical therapy. Two other groups concur with this recommendation and also emphasize the importance of adjunctive antibiotics prior to nephrectomy [29,30]. This two-stage approach was clearly necessary for our patient, given his extensive infection, fibrosis, and adhesions.…”

Section: Discussionsupporting

confidence: 64%

Diffuse xanthogranulomatous pyelonephritis in a child with severe complications

et al. 2004

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Xanthogranulomatous pyelonephritis is a rare disease in childhood. Because the symptoms and signs are chronic and non-specific, preoperative diagnosis is usually difficult. We report an 8-year-old boy who had an abdominal mass and anemia for more than 6 months. Fever and dyspnea occurred 4 days prior to admission. Ultrasonography revealed an enlarged right kidney with multiple parenchymal hypoechogenic areas, absence of normal parenchymal structures, and perinephric thickening with multiple calcifications. An abdominal computed tomogram demonstrated an irregular, enlarged right kidney with multiple low-density round areas consistent with hydronephrosis and calculi. Diminished excretion of contrast media and a severe perinephric inflammatory reaction were present. Poor right kidney function was demonstrated by Tc99m-diethylenetriamine penta-acetic acid split renal function examination. We diagnosed xanthogranulomatous pyelonephritis preoperatively based on the clinical and radiological features. The child first had drainage of an extrarenal abscess and antibiotic therapy, followed by definitive nephrectomy. The hospital course was complicated with pleural effusion, peritonitis, pelvic abscess, and sepsis. A two-stage nephrectomy requiring less radical resection and decreasing the surgical complications would have been preferable.

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Section: Discussionsupporting

confidence: 64%

Diffuse xanthogranulomatous pyelonephritis in a child with severe complications

et al. 2004

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“…Total nephrectomy is the standard of treatment in diffuse forms. 23 In focal forms, first-line antibiotic therapy is advocated, with no recurrence reported in published studies. [24][25][26][27] Medical treatment avoids a decaying surgery and offers nephronsparing.…”

Section: Discussionmentioning

confidence: 99%

Xanthogranulomatous pyelonephritis presenting as a pseudotumour

Chlif

Chakroun

Rhouma

et al. 2016

CUAJ

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Original research E36case series AbstractIntroduction: Xanthogranulomatous pyelonephritis (XGPN) is an atypical form of chronic pyelonephritis referred to as the ''great imitator'' because the clinical and radiological findings closely resemble other pathological entities, especially for the focal forms. Distinguishing focal XGPN from renal cancer is preoperatively difficult. Methods:We report a total number of 12 pseudotumoural XGPN cases diagnosed and treated in our department. The aim of this study is to try to better understand the clinicopathological profile of XGPN and improve its management. Results: The mean age of patients was 51.52 years. Gender ratio was 0.71. An obstructive renal calculus was noticed in nine patients (75%). Only one patient (8.3 %) presented with loin pain associated with fever, weight loss, asthenia, and increased biological inflammation markers. A bifocal mass was noticed in one case (8.3 %). The average size of the tumour was 6.58 cm. The mass was cystic in three cases (25 %). Perinephral fat strand, thickening of Gerota's fascia, hydronephrosis, and presence of renal calculi was noticed in all solid tumour cases. XGPN was suspected in only one case (8.3%), a percutaneous biopsy showed XGPN lesions treated by antibiotics and a double J drainage. Radical nephrectomy was performed in eight patients (66.7 %) and three patients underwent partial nephrectomy (25 %). No recurrence of XGPN has been noted. Conclusion: Pseudotumoural XGPN is a rare benign disease of the kidney. Its treatment should be conservative. Lack of knowledge of this disease may explain the high rate of abusive nephrectomies. These data should be considered in the future.

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“…The differential diagnoses of renal mass associated with pyelo-calyceal involvement included Wilms' tumour [22,23], renal cell carcinoma [35], xanthogranulomatous pyelonephritis [1][2][3], malakoplakia [4][5][6], inflammatory pseudotumour of the renal pelvis [7][8][9], renal lymphoma [36], and fungal infection [10,11]. In our patient the lesion could not be identified preoperatively; hence, a needle biopsy was performed.…”

Section: Commentarymentioning

confidence: 93%

“…The renal scintigraphic patterns were independently interpreted by two senior nuclear medicine physicians who used standard criteria previously defined by Patel et al [15]. Diethyl triamine penta-acetic acid (DTPA) or mercapto-acetyl triglycerine (MAG 3) are more appropriate to evaluate renal function and flow, but, in accordance with some studies [3][4][5] and for our patient, renal scintigraphy with technetium-99 m-labelled DMSA was considered the imaging agent of choice for estimating the presence and extent of acute renal parenchymal changes.…”

Section: Commentarymentioning

confidence: 99%