Xanthogranulomatous Pyelonephritis (XGPN) in a Child with Multiple Ureteric Calculi.

Xanthogranulomatous pyelonephritis (XGPN) is an unusual suppurative granulomatous reaction to chronic renal infection, often in the presence of chronic obstruction, characterised histologically by granulomatous reaction with giant cells and foamy histiocytes1. XGPN is rare in children2. We report a case of XGPN, in a child with multiple lower ureteric calculi. An 11 year old male child presented to us, with features suggestive of acute pyelonephritis of two months duration.complete evaluation including contrast CT of the abdomen a diagnosis of XGPN was made. As the renal unit in question was non functional, he was treated successfully by subcapsular nephrectomy. This case is presented to emphasise the fact that, it is very important to diagnose XGPN early and differentiate it from chronic pyelonephritis. Prolonged antibiotic therapy and surgery is invariably required to relieve the obstruction and to eradicate the infection in patients with XGPN.

Xanthogranulomatous pyelonephritis in children and adults--an 8 year study.

20 cases of Xanthogranulomatous Pyelonephritis (XPN) were encountered over an 8 year period, constituting 0.4 percent of the total of 47,370 surgical biopsies, 10 percent of the total of 188 nephrectomy specimens removed for various reasons and 35 percent of the nephrectomy specimens associated with chronic pyelonephritis. This is the largest single series, reported in Indian literature. 16 patients were adults and 4 were children, thus 25 percent of our cases were children, a significantly high proportion. Our youngest patient a 5 1/2 month old male, is to the best of our knowledge, the youngest case reported from India. Males predominated in our series, the M:F ratio being 3:1, this contrasts with western literature in which there is a definite female preponderance. The common presenting symptoms were lumbar pain, fever and palpable non-functioning kidney. 4 cases were complicated by cutaneous sinuses. There was a slight predominance of affectation of the left side over the right side. On gross examination, diffuse lesions were commoner than focal lesions and were seen in children as well. An accurate pre-operative diagnosis was made in only 2 cases, in the rest, the diagnosis was either tuberculosis or pyonephrosis. Thus XPN is quite frequently seen in the adult Indian population and is not as rare in children, as it was once thought to be.

Xanthogranulomatous pyelonephritis--(a clinicopathological study of 15 cases)

The clinico-pathological features of 15 patients with xanthogranulomatous pyelonephritis (XGP) are described and the probable histogenesis is discussed. Based on our data and the review of literature, we believe that XGP should be regarded as a destructive and at times tumefactive inflammatory process that may complicate chronic pyelonephritis. The initiation of this process remains obscure, but the features commonly associated with XGP are pelvi-calyceal obstruction, ulceration of the pelvic urothelium with collection of necrotic material and bacterial infection.