Abstract:SummaryXanthogranulomatous pyelonephritis (XGPN) is a rare, severe and atypical form of chronic pyelonephritis. It is characterised by destruction of the renal parenchyma and replacement with a chronic inflammatory infiltrate and lipid-laden macrophages resulting in a non-functional kidney. The authors report a case of a 5-year-old boy presented with a history of abdominal pain, malaise, anorexia and weight loss for 2 months. Physical examination revealed a large flank mass and the child was directed to the on… Show more
Xanthogranulomatous pyelonephritis (XPN) is an unusual and severe form of chronic inflammatory lesion of the kidney, characterised by the destruction of the renal parenchyma and the presence of multinucleated giant cells and lipid-laden macrophages, inflammatory infiltration and intensive renal fibrosis. There are a few cases in the literature which describe the disease in children. The pathomechanism of XPN is poorly understood. Renal obstruction with concomitant urinary tract infection is the most commonly associated pathological finding. The process is typically unilateral and may be focal or diffuse. In both cases, the perirenal infiltration is possible and can be mistaken for common renal neoplasm or inflammatory process. The symptoms are non-specific. Diagnostic imaging techniques with clinical suspicion have enabled XPN to be diagnosed and differentiated from malignancy with a high degree of confidence. Computed tomography (CT) is the mainstay of diagnostic imaging. The definitive diagnosis of XPN is based on pathological assessment after nephrectomy. We review and illustrate the clinical, radiological, surgical and pathological characteristics of XPN in children. All cases shown are surgically and histopathologically proven.Teaching Points
• XPN can present different clinical manifestations.
• CT is the mainstay of diagnostic imaging in XPN.
• Focal type of XPN should be included in the differential diagnosis of children with a renal mass.
• There are no clear guidelines on the management of XPN.
• Conservative and surgical treatments should be considered for each individual case.
• Histopathological examination confirms the diagnosis and excludes other benign and malign diseases.
Xanthogranulomatous pyelonephritis (XPN) is an unusual and severe form of chronic inflammatory lesion of the kidney, characterised by the destruction of the renal parenchyma and the presence of multinucleated giant cells and lipid-laden macrophages, inflammatory infiltration and intensive renal fibrosis. There are a few cases in the literature which describe the disease in children. The pathomechanism of XPN is poorly understood. Renal obstruction with concomitant urinary tract infection is the most commonly associated pathological finding. The process is typically unilateral and may be focal or diffuse. In both cases, the perirenal infiltration is possible and can be mistaken for common renal neoplasm or inflammatory process. The symptoms are non-specific. Diagnostic imaging techniques with clinical suspicion have enabled XPN to be diagnosed and differentiated from malignancy with a high degree of confidence. Computed tomography (CT) is the mainstay of diagnostic imaging. The definitive diagnosis of XPN is based on pathological assessment after nephrectomy. We review and illustrate the clinical, radiological, surgical and pathological characteristics of XPN in children. All cases shown are surgically and histopathologically proven.Teaching Points
• XPN can present different clinical manifestations.
• CT is the mainstay of diagnostic imaging in XPN.
• Focal type of XPN should be included in the differential diagnosis of children with a renal mass.
• There are no clear guidelines on the management of XPN.
• Conservative and surgical treatments should be considered for each individual case.
• Histopathological examination confirms the diagnosis and excludes other benign and malign diseases.
“…However, there have been reports of successful treatments of focal XGP with medical intervention only [10]. Preoperative and postoperative broad-spectrum antibiotics should also be as key factors for successful management of XGP [16]. As was seen in our patient, psoas abscess is rare with XGP, but when it occurs, the diagnosis and management of the cases are more complicated.…”
Section: Discussionmentioning
confidence: 78%
“…These cells can be difficult to distinguish from clear cell carcinoma [3]. The long-standing mainstay of therapy for diffuse XGP disease is total nephrectomy but partial nephrectomy is advocated whenever possible (focal or bilateral lesions) [3,[15][16][17]. However, there have been reports of successful treatments of focal XGP with medical intervention only [10].…”
A B S T R A C TXanthogranulomatous pyelonephritis (XGP) is a rare variant of chronic pyelonephritis. We report a case of a 7 year girl with fever and recurrent left flank pain with a nonfunctioning left kidney. Left psoas abscess was aspirated under ultrasound guidance and appropriate antibiotics were administered. Left nephrectomy was done for the nonfunctioning kidney. Histopathology was suggestive of XGP. The patient is asymptomatic on follow up.
“…83% of the time, a calculus is found, and 50% of the time it is a staghorn calculus.14 Even though both kidneys are affected equally by XGPN, bilateral variations have been reported. 15 Some researchers claim that a rare form of pyelonephritis called XGPN affects less than 1.5% of cases of renal inflammation. a nephrocutaneous fistula exists.…”
The uncommon condition known as xanthogranulomatous pyelonephritis (XGP) is characterized by renal parenchymal loss and is replaced by solid sheets of lipid-rich macrophages. Most cases affect women in their mid-twenties. A histopathologic analysis provides a precise diagnosis. The only effective treatment is a whole or partial nephrectomy. Nephrostomy is our suggested procedure because it makes microbiological diagnosis and operation easier (nephrectomy). Here we discussed a case of xanthogranulomatous pyelonephritis with staghorn calculus and its surgical management. The present complaints and investigation: A 38-year-old woman who had been experiencing right flank pain for two to three months and a high-grade fever registered with the urology department. She has a history of anemia. Now she has come here for further treatment. The doctor made the diagnosis of xanthogranulomatous pyelonephritis with staghorn calculus following a physical examination and further testing like blood and urine analysis. Inj. Ceftraxone 1 gm BD, Tab. Pantop 40 Mg OD, Inj. Emset 4 Mg SOS, Inj. Tramadol TDS, Calcium, iron, and folic acid supplements were given.conclusion: Her general condition was good and all treatment was completed.
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