Korean J Transplant.  2023 Nov;37(Suppl 1):S181. 10.4285/ATW2023.F-7677.

Clinical treatment experience of xanthogranulomatous pyelonephritis in both native kidneys 20 years after kidney transplantation

• Hwang H
• Yang JD
• Lee MR
• Chung BH
• Kim MK
• Lee S
• Seong S
• Lee SM
• Hwang KH
• Yu HC

• KMID: 2551801
• DOI: http://doi.org/10.4285/ATW2023.F-7677

Abstract

Xanthogranulomatous pyelonephritis is a rare condition, which is rarer still in an allograft recipient. The disease was first described in 1984 in a single native kidney following a living donor kidney transplantation and was surgically treated. We have clinical experience of this situation. A 66-year-old male visited for fever and flank pain. He had diabetes, hypertension, and surgical history of kidney transplantation from nonrelated living donor 20 years ago. Computed tomography scan showed hydronephrosis of transplanted kidney and right native kidney and ureteritis. Although empirical antibiotic therapy has relieved fever and pain, abdominal discomfort and leukocytosis persisted for more than 2 weeks. After in-depth and candid consultation with the patient, the patient agreed to resection of the right kidney. Tissue obtained after robotic nephrectomy was diagnosed as xanthogranulomatous pyelonephritis based on pathological findings. However, in the patient who visited the hospital again with the same symptoms, hydronephrosis and ureteritis of the left native kidney were observed this time. One month after the right nephrectomy, we performed a left nephrectomy again, and the histological findings also concluded that it was xanthogranulomatous pyelonephritis. The patient is currently improving after emergency open surgery due to early sepsis due to adhesive enteritis and acute abdominal pain during the recovery process.