Xanthogranulomatous pyelonephritis with calculus migration into the psoas abscess: an unusual complication

Xanthogranulomatous pyelonephritis (XGP) is a rare variant of chronic pyelonephritis. It is characterized by progressive parenchymal destruction caused by chronic renal obstruction due to calculus, stricture, or rarely tumor, resulting in kidney function loss. Herein, we describe the case of a 36-year-old female who presented with left loin pain, left lower limb pain, and dysuria. On contrast-enhanced computed tomography (CECT), multiple abscesses and an obstructive staghorn calculus were depicted in the left kidney with the classical appearance of "Bear Paw Sign." An abscess with calculi was also present within the left psoas muscle. Though psoas muscle abscess in association with XGP was described, a ureteric fistula and calculi within the psoas muscle have not yet been reported in the literature. Left nephrostomy was performed, which came out to be positive for E. coli on culture. The patient underwent left nephrectomy, and the histopathological report of the surgical specimen confirmed XGP.

Extensive renal sinus lipomatosis in xanthogranulomatous pyelonephritis simulating liposarcoma

ABSTRACT Renal replacement lipomatosis is a condition characterized by varying degrees of renal parenchymal atrophy and perirenal fibrofatty proliferation secondary to chronic inflammation such as xanthogranulomatous pyelonephritis. In severe cases, imaging findings can be misdiagnosed as retroperitoneal liposarcoma.

Pielonefritis xantogranulomatosa en adultos: presentación de 15 casos clínicos / Xanthogranulomatous pyelonephritis in adults: presentation of 15 clinical cases

Reportar nuestra experiencia en pielonefritis xantogranulomatosa (PXG), para contribuir al conocimiento de la misma. Material y métodos: análisis retrospectivo de las nefrectomías de los pacientes con diagnóstico histopatológico de PXG, entre los años 2002 y 2010. Resultados: se estudiaron 15 casos, 12 mujeres y 3 varones, con una edad promedio de 46,7 años. Todos los pacientes presentaron evolución crónica, malestar general, dolor abdominal y/o lumbar. La fiebre, palidez conjuntival, presencia de litiasis renal y pérdida de peso, fueron síntomas frecuentes. El laboratorio de sangre mostró eritrosedimentación muy incrementada y leucocitosis. La orina se presentó con sedimento alterado mostrando: hematuria, piuria y bacteriuria. En menos de la mitad de los casos el urocultivo presentó desarrollo y en algunas oportunidades con flora polimicrobiana y discrepancia en las recuperaciones por nefrostomías y cultivos convencionales. Los estudios por imágenes mostraron un riñón aumentado de tamaño, con presencia de litiasis en su mayoría y diversas alteraciones estructurales. Conclusiones: la PXG es una enfermedad infrecuente, crónica, benigna infecciosa e inflamatoria que afecta al parénquima renal. Poses predilección por el sexo femenino de mediana edad. El diagnóstico se efectúa ante la sospecha clínica, los estudios de laboratorio, de imágenes y se confirma con la histopatología. El tratamiento definitivo es la nefrectomía...

To report our experience, to contribute to the knowledge about, Xanthogranulomatous Pyelonephritis (XGP). Material and Methods: Retrospective analysis of the nephrectomy of patients with histopathological diagnosis of XGP, between 2002 and 2010. Results: We studied 15 cases, 12 women and 3 men, with an avergage age of 46.7 years. All patientes had chronic evolution, malaise, abdominal pain and/or lumbar spine. Fever, pallor, presence of kidney stones and weight loss were common symptoms. Blood laboratory presented increased erythrocyte sedimentation rate and leukocytosis. The urine was presented showing altered sediment, hematuria, pyuria and bacteriuria. In less than half of the cases the urine culture showed developed, sometimes with polymicrobial flora and discrepancy in recoveries by nephrostomy and conventional cultures. Imaging studies showed an increased kidney size, resence of stones in the most cases and various structural abnormalities. Conclusions: XGP is rare, chronic, infectious and inflammatory beningn disease that affects renal parenchyma and usually presents in middle-aged female. Diagnosis is suspected by clinic, laboratory, imaging studies, and confirmed by histopathology. Nephrectomy is the definitive treatment...

Xanthogranulomatous pyelonephritis

We conducted this study at Mansoura Urology and Nephrology Centre on thirty nine histopathologically proved XGP. Clinical, laboratory, radiological features and treatment modalities, histopathological correlation and possible risk factors are presented. We reviewed the computed charts of thirty nine patients with XGP seen at our centre, between January 1992 and July 2006. Demographic data of patients, laboratory and imaging studies, treatment modalities and perioperative complication were discussed. There were 13% of cases below 18 years of age, and 87% more than 18 years. Flank pain was the major presenting complaint in 82%, and discharging sinus in 10%, the second. All patients had normal renal function tests, rheumatoid factor [RF] was positive in about 48.7%, urine culture sensitivity was positive for bacterial growth in 48.7%, nephrolithiasis were found in 84,6%, there was one case with focal XGP which was treated by partial nephrectomy and another case underwent pyelolithotomy with partial nephrectomy while the remaining 37 cases underwent total nephrectomy one of them via laproscopy. Perioperative complication included, pleural tear [3 patients], colonic injury [one patient], septicaemia [5 patients] and hepatic injury [one patient]. The aetiology of XGP remains a mystery although it is usually associated with urinary tract obstruction, infection and urolithiasis and this issue is supported in our series and we noticed that rheumatoid factor is positive in almost half [48,7%] of cases, which could be attributed as a risk factor. Perinephric discharging sinus was not uncommon [10% of our cases]. Because of chronicity and massive fibrosis the perioperative complicatons were significant so diligent dissection was required. Attacks of pain, positive RF with or without nephrolithiasis and perinephric collection raise the suspicion of XGP and more conservative treatment modalities can be applied, since there have been reports of successful medical treatment of focal XGP

Emphysematous pyelonephritis and Xanthogranulomatous pyelonephritis in contra-lateral kidney: an extremely rare condition

A case of 50-year old woman with diabetes, hypertension, chronic liver disease secondary to hepatitis C virus and end-stage renal disease on dialysis, was admitted to the surgical unit of Aseer Central Hospital with the complaints of right loin pain and fever for two weeks. She was diagnosed to have right emphysematous pyelonephritis. Emergency nephrectomy was done for the patient. Three years earlier, the patient was admitted to our hospital with a suspicion of left renal tumour. Left partial nephrectomy was done and histopathology confirmed the diagnosis of Xanthogranulomatous pyelonephritis. The details of this rare occurrence are documented in this case

Xanthogranulomatous Pyelonephritis due to calculi: report of 63 cases and review of literature

To examine the relationship between clinical history and results of renal investigations in patients with xanthogranulomatous pyelonephritis. A retrospective review was conducted on 63 cases presenting with histopathological diagnosis of xanthogranulomatous pyelonephritis between 1995 to 2002, at the department of Urology, Bolan Medical College and Sandeman Provincial Teaching Hospital Quetta. There were 26 males and 37 females having an average follow up of two years. Positive findings on examination and investigations at presentation were fever and flank pain in 59 [93.6%] patients and pyuria in 34 [53.9%] patients. All the patients had renal and ureteric calculi with no or severe reduction in the function of the affected kidney on DTPA scan. Hypertrophy of the contra lateral kidney was seen in 56[88.8%] patients. Xanthogranulomatous pyelonephritis is a common entity in this part of the world. Late referral leads to loss of the kidney. Pre-operative diagnosis of the condition is desirable and if surgery is mandatory then all infected tissues have to be removed

Fístula nefrobrônquica em paciente com infecção por "Pasteurella aerogenes" / Nephrobronchial fistula due to Pastereula aerogenes infection

Apresenta-se o caso de uma paciente com nefrolitíase que, após submeter-se a uma litotripsia, evoluiu com pielonefrite xantogranulomatosa, fístula nefrobrônquica, abscesso pulmonar e septicemia. O tratamento incluiu drenagem da loja renal, drenagem tubular da pleura e do abscesso pulmonar por toracotomia e nefrectomia direita. A bactéria isolada, tanto da loja renal, quanto do abscesso pulmonar, foi a Pasteurella aerogenes, sendo este o primeiro caso na literatura médica mundial relacionado a este patógeno

Pielonefritis xantogranulomatosa: Problema de diagnóstico clínico / Pyelonephritis xantogranulomatous: A clinical diagnostic problem

Se presenta un caso de pielonefritis xantogranulomatosa, ocurrido en un hospital general de mujeres. Se hace énfasis en el diagnóstico clínico diferencial, la histopatología, y la posibilidad del tratamiento médico oportuno por medio del conocimiento de la enfermedad y el diagnóstico por imágenes.

Pielonefritis xantogranulomatosa / Xanthogranulomatous pyelonephritis

La Pielonefritis Xantogranulomatosa (PNX) es una entidad poco frecuente e importante en el diagnóstico diferencial de enfermedades renales como riñon multiquístico, carbuncio renal e hipernefroma, y es de particular importancia enfatizar que la nefrectomía parcial o total es curativa en estos casos. Se realizó un análisis retrospectivo de 88 historias clínicas de pacientes con diagnóstico confirmado de PNX, registrados entre los años 1969-1986. Se encontró una edad x = 41.25 ñ 18.72 y el 100% correspondió al sexo femenino. En el cuadro clínico se presentó dolor, pérdida de peso y síntomas urinarios en el 87.5%. Antecedentes de infección del tracto urinario (ITU) en el 71.4% y litiasis urinaria (sin historia de eliminación) en el 86%. Entre los hallazgos clínicos obtuvimos dolor y masa abdominal en el 87.5%, palidez y puño percusión lumbar (PPL) exquisita en el 75% y fiebre en el 50%./ Urocultivo positivo, principalmente enteropatógenos en el 75%. En la urografía escretoria observamos riñón ecluído en el 100% y cálculo coraliforme en el 75%. En la ecografía el patrón fue de riñón con múltiples cavidades e hidronefrosis. En este trabajo se presenta, además, un caso clínico de cálculo coralifrome bilateral asociado a acidosis tubular distal no descrito en la literatura y que podría tener importancia en la patogénesis de la enfermedad

Pielonefritis xantogranulomatosa en un adolescente / Xanthogranulomatous pyelonephritis in an adolescent

Se describe 1 caso de pielonefritis xantogranulomatosa que fue diagnosticado luego de nefrectomía y con algunas características destacables como ser, adolescente varon, riñón derecho afectado y funcionante, sin antecedentes previos patológicos, de las que no encontramos explicación en la revisión bibliográfica realizada. La pielonefritis xantogrnaulomatosa se observa usualmente en mujeres en la sexta década de la vida y la presunción sugiere tumor renal. El 50% de los casos se asocia a cultivos de orina positivos para Escherichia coli o Proteus mirabilis según diferentes series; en más del 90% de los casos, el cultivo del tejido renal afectado es bacteriológicamente positivo. Desnutrición, urolitiasis, calcificación y riñón no funcionante, con hidronefrosis, son los hallazgos comunes en esta enfermedad. El riñón ezquierdo es el más frecuentemente comprometido. La etiología es poco clara y se discuten varias hipótesis, siendo la desnutrición y la deficiencia de peroxidasas las que tienen mayor aceptación

Pielonefrite xantogranulomatosa / Xanthogranulomatous pyelonepohritis

Os autores abordam aspectos gerais da patologia, analisando os casos reportados segundo as observaçöes clínicas, anatomopatológicas, laboratoriais e radiológicas referentes a esta entidade. Säo apresentados três casos, ressaltando os autores a dificuldade de diagnóstico, devido à inespecificidade dos exames clínicos, laboratoriais e radiológicos