RESUMO
OBJECTIVE: To review and evaluate patients with a clinicopathological diagnosis of xanthogranulomatous pyelonephritis (XGP) with emphasis on the diagnostic methods and the effect of socioeconomic status on disease severity. METHODS: Data compiled from the previous history of the patients, clinical, laboratory, radioimaging findings, preoperative, operative, histopathological diagnosis and postoperative follow-up period were analysed. On the basis of presentation, XGP was classified as complicated and simple. RESULTS: There were 18 cases of XGP. The clinical characteristics included: calculi or obstruction in the urinary tract, and damage to the kidney, complication of urinary tract infection, anaemia, increased erythrocyte sedimentation rate and liver dysfunction. All patients had diffuse XGP. Associated pathological findings such as psoas abscess, nephrocutaneous fistula, renocolonic fistula and paranephric abscess were found in 33.3% of cases. Eleven of 14 patients (78.6%) who were evaluated by computed tomography (CT) had the correct diagnosis made prior to nephrectomy. Urine culture was positive in 88.9% of patients and Proteus mirabilis was the most common organism. CONCLUSION: Our experience with a small number of patients demonstrates that low socioeconomic status could be a risk factor in the development of complicated cases of XGP. CT is considered to be the best radiological test for correct preoperative diagnosis and evaluation of XGP. Nephrectomy and removal of all surrounding affected tissue proved to be curative for XGP.
Assuntos
Pielonefrite Xantogranulomatosa , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Interpretação Estatística de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrectomia , Pielonefrite Xantogranulomatosa/classificação , Pielonefrite Xantogranulomatosa/complicações , Pielonefrite Xantogranulomatosa/diagnóstico , Pielonefrite Xantogranulomatosa/diagnóstico por imagem , Pielonefrite Xantogranulomatosa/epidemiologia , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Tomografia Computadorizada por Raios XRESUMO
Presentamos dos casos clínicos de pielonefritis xantogranulomatosa (PNX) en la infancia. En los dos casos la clínica fue inespecífica y se demostró infección urinaria asociada. En uno de ellos el diagnóstico fue preoperatorio, según las nuevas técnicas de imagen (AU)
We report two cases of xanthogranulomatous pyelonephritis in children. In both cases, the symptoms were nonspecific, but the presence of urinary tract infection was demonstrated. One case coud be diagnosed preoperatively on the basis of new imaging techniques (AU)
Assuntos
Criança , Humanos , Pielonefrite Xantogranulomatosa/classificação , Pielonefrite Xantogranulomatosa/diagnóstico , Pielonefrite Xantogranulomatosa/patologiaRESUMO
Based on the evidence obtained on 28 cases of xanthogranulomatous pyelonephritis (XP), the authors suggest to distinguish two XP clinical forms: obstructive and nonobstructive. The former may occur in noticeable destruction of renal tissue and urine retention secondary, most frequently, to long-standing nephrolithiasis. The latter simulates by symptoms and examination results renal carcinoma. In suspicion of nonobstructive XP, the surgeon should consider fast-made intraoperative biopsy to decide on feasibility of sparing intervention.
