Korean J Urol.  2011 Jun;52(6):421-424.

Xanthogranulomatous Pyelonephritis: A Retrospective Review of 16 Cases

• Siddappa S
• Ramprasad
• Muddegowda MK

Abstract

PURPOSE
Xanthogranulomatous pyelonephritis is an uncommon disorder of unknown etiology that is characterized by extensive destruction of the involved kidney. It is being increasingly recognized as an important cause of renal morbidity around the world.
MATERIALS AND METHODS
This retrospective study was undertaken to review the xanthogranulomatous pyelonephritis cases presented at our tertiary care referral center in Bangalore, India.
RESULTS
A total of 16 biopsy-proven cases of xanthogranulomatous pyelonephritis from October 2007 to March 2010 treated at our institute were included in the study. There were 10 females and 6 males with a mean age of 51.5 years. Flank pain was the most common presenting symptom followed by fever. All patients had unilateral disease and underwent total nephrectomy of the affected nonfunctional kidney.
CONCLUSIONS
Xanthogranulomatous pyelonephritis is a chronic and unusual infectious inflammatory condition involving the renal parenchyma. The definite treatment is nephrectomy. Early identification and prompt treatment of this relatively benign and uncommon condition is important to minimize morbidity and mortality.

Keyword

Nephrectomy; Pyelonephritis; Xanthogranulomatous

MeSH Terms

Female
Fever
Flank Pain
Humans
Kidney
Male
Nephrectomy
Pyelonephritis
Pyelonephritis, Xanthogranulomatous
Referral and Consultation
Retrospective Studies
Tertiary Healthcare

Figure

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  FIG. 1 Cut surface of the kidney with variegated appearance. Arrows correspond to clear vacuolated white areas of xanthogranulomatous pyelonephritis.

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  FIG. 2 Bold arrows show glomeruli and the other two arrows show mature adipocytes.

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  FIG. 3 X-ray of abdomen showing staghorn calculi.

Reference

1. Tilkoff-Rubin NE, Cotran RS, Rubin RH. Brenner BM, editor. Urinary tract infection, pyelonephritis, and reflux nephropathy. Brenner & Rector's The Kidney. 2004. 7th ed. Philadelphia: Saunders;1554–1555.

2. Matthews GJ, McLorie GA, Churchill BA, Steckler RE, Khoury AE. Xanthogranulomatous pyelonephritis in pedriatric patients. J Urol. 1995. 153:1958–1959.

3. Lee HN, Kim KH, Ryu IW, Han MC, Chung WS. Xanthogranulomatous pyelonephritis in an infant. Korean J Urol. 2006. 47:1367–1370.

4. Parsons MA, Harris SC, Longstaff AJ, Grainger RG. Xanthogranulomatous pyelonephritis: a pathological, clinical and aetiological analysis of 87 cases. Diagn Histopathol. 1983. 6:203–219.

5. Jung TS, Cho KH, Yang WJ, Song YS, Park YH, Park SM, et al. Xanthogranulomatous pyelonephritis with spontaneous nephrocutaneous fistula. Korean J Urol. 2008. 49:1158–1160.

6. Grainger RG, Longstaff AJ, Parsons MA. Xanthogranulomatous pyelonephritis: a reappraisal. Lancet. 1982. 1:1398–1401.

7. Rosi P, Selli C, Carini M, Rosi MF, Mottola A. Xanthogranulomatous pyelonephritis: clinical experience with 62 cases. Eur Urol. 1986. 12:96–100.

8. Smith FR. Bilateral xanthogranulomatous pyelonephritis. Br J Urol. 1981. 53:81.

9. McDonald GS. Xanthogranulomatous pyelonephritis. J Pathol. 1981. 133:203–213.

10. Eastham J, Ahlering T, Skinner E. Xanthogranulomatous pyelonephritis: clinical findings and surgical considerations. Urology. 1994. 43:295–299.

11. Tolia BM, Iloreta A, Freed SZ, Fruchtman B, Bennett B, Newman HR. Xanthogranulomatous pyelonephritis: detailed analysis of 29 cases and a brief discussion of atypical presentations. J Urol. 1981. 126:437–442.

12. Van Vlem B, Billiouw JM. Images in clinical medicine. Xanthogranulomatous pyelonephritis. N Engl J Med. 2000. 342:1572.

13. Kim YJ, Huh JS. Clinical characteristics of xanthogranulomatous pyelonephritis. Korean J Urol. 2004. 45:935–940.

14. Levy M, Baumal R, Eddy AA. Xanthogranulomatous pyelonephritis in children. Etiology, pathogenesis, clinical and radiologic features, and management. Clin Pediatr (Phila). 1994. 33:360–366.

15. Malek RS, Elder JS. Xanthogranulomatous pyelonephritis: a critical analysis of 26 cases and of the literature. J Urol. 1978. 119:589–593.

16. Papadopoulos I, Wirth B, Wand H. Xanthogranulomatous pyelonephritis associated with renal cell carcinoma. Report on two cases and review of the literature. Eur Urol. 1990. 18:74–76.

17. Matsuoka Y, Arai G, Ishimaru H, Takagi K, Aida J, Okada Y. Xanthogranulomatous pyelonephritis with a renocolic fistula caused by a parapelvic cyst. Int J Urol. 2006. 13:433–435.

18. Alan C, Ataus S, Tunç B. Xanthogranulamatous pyelonephritis with psoas abscess: 2 cases and review of the literature. Int Urol Nephrol. 2004. 36:489–493.

19. Sherman SC, Limkakeng A. Xanthogranulomatous pyelonephritis with a nephrocutaneous fistula. J Emerg Med. 2005. 29:337–338.

20. Park S, Ji YH, Cheon SH, Kim YM, Moon KH. Urachal xanthogranuloma: laparoscopic exicision with minimal incision. Korean J Urol. 2009. 50:714–717.

21. Tiu CM, Chou YH, Chiou HJ, Lo CB, Yang JY, Chen KK, et al. Sonographic features of xanthogranulomatous pyelonephritis. J Clin Ultrasound. 2001. 29:279–285.