Xanthogranulomatous pyelonephritis in childhood

Giant pyonephrosis related to nephrolithiasis in diabetes woman: A case report

Pyelonephritis is one of the main systemic bacterial infections encountered in emergency departments. We present a case of diabetes woman aged 30 years referred to our urology department of El-Idrissi Hospital, Kenitra (Morocco) for recurrent episodes of urinary tract infection, multiple urolithiasis, chills, unilateral lower back pain, chills and severe hydroureteronephrosis. Abdominal CT showed a non-functioning obstructed kidney with pyelic and ureteral stones. Nephroureterectomy was performed by extraperitoneal nephrectomy for avoiding any more extended nephrectomy incision or second iliac incision, this technic ensures nephroureterectomy with minimal risk of affecting the distal ureter, that sometimes follows nephrectomy. Diabetes and urolithiasis coexistence in a patient may cause severe pyonephrosis leading to nephroureteroctomy.

Xanthogranulomatous pyelonephritis in a pediatric patient

Introduction:

Xanthogranulomatous pyelonephritis consists of a chronic infectious and inflammatory process of the renal parenchyma, a variant of chronic obstructive pyelonephritis. It is more prevalent in middle-aged adults, rare in pediatric patients, with less than 300 cases reported in children worldwide.

Report:

Preschooler, aged 2 years and 11 months, male, with 2 months of abdominal distention, increased temperature and intense pallor, associated with microcytic anemia refractory to the use of ferrous sulfate. 1 week before, he had a bulging in his left flank and a hard palpable mass there. Imaging exams (ultrasound and tomography) revealed an overall enlargement of the left kidney, destruction of the renal parenchyma and intense calyceal dilation, forming the "bear's paw" sign, with a staghorn calculus in the pelvis. He underwent treatment with antibiotic therapy and total nephrectomy, with a specimen sent for pathological examination.

Discussion:

a disease of uncertain incidence in the pediatric age group, xanthogranulomatous pyelonephritis is more prevalent in male children and affects mainly the left kidney, being frequently associated with the presence of stones. Clinically, it has nonspecific symptoms, the most common being abdominal distension and asthenia. Laboratory exams shows microcytic, leukocytosis, thrombocytosis and increased inflammation, pyuria, hematuria and proteinuria, in addition to bacterial growth in urine culture. The diagnosis is anatomopathological, but it can be hinted by contrasted CT scan, with the classical sign of the "bear's paw". Treatment may include nephrectomy and broad-spectrum antibiotic therapy.

Xanthogranulomatous Pyelonephritis: A Complicated Febrile Urinary Tract Infection Detected by Point-of-Care Ultrasound in the Emergency Department

BACKGROUND

Febrile urinary tract infections (UTIs) include a spectrum of pathologies from uncomplicated pyelonephritis to urosepsis, including xanthogranulomatous pyelonephritis (XGP). Most febrile UTIs are treated with antibiotics alone, but studies indicate nearly 12% of cases of presumed simple pyelonephritis require emergent urologic intervention. How to identify these individuals, while limiting unnecessary advanced imaging and delays in diagnosis, challenges all emergency providers. We review the diagnosis and management of XGP, as well as the evidence regarding the role of renal ultrasound in the identification of complicated presentations of febrile UTIs.

CASE REPORT

We present a case of XGP, a complicated febrile UTI requiring immediate urologic intervention, diagnosed by point-of-care ultrasound. A 40-year-old female presented in severe sepsis and complaining of flank pain. Prompt bedside ultrasound demonstrated hydronephrosis, expediting definitive urologic treatment via percutaneous nephrostomy tube placement. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: With a mortality rate exceeding 40%, obstructed pyonephrosis requires prompt decompression. Given its exceptional sensitivity for identifying hydronephrosis and ability to detect abscesses and emphysematous changes, we advocate a point-of-care ultrasound-first approach to screen for cases of complicated febrile UTIs in order to expedite treatment and limit radiation in uncomplicated presentations.

Xanthogranulomatous pyelonephritis in a paediatric cohort (1963-2016): Outcomes from a large single-center series

BACKGROUND

Xanthogranulomatous pyelonephritis (XGP) is an uncommon chronic destructive granulomatous inflammation of the kidney. It was first described in 1916, and is thought to affect 6/1000 cases of pyelonephritis. Its manifestations are varied, and with a limited number of cases in the literature, the optimal diagnosis and management of XGP in the paediatric cohort is still unknown.

MATERIAL AND METHODS

The medical records of children who were diagnosed and treated for XGP at the current unit during the period 1963-2016, inclusive, were retrospectively reviewed. Information pertaining to each patient was recorded, including: demographic data, past medical history, clinical and biochemical characteristics, diagnostic procedures, treatment methods, histopathologic diagnosis of the removed specimen, and outcome.

RESULTS

A total of 66 children with a median age of 4.84 years (range 1.1-14.81), with an M:F ratio 1.35:1 underwent nephrectomy for XGP and had a median follow-up of 7.19 years (range 0.11-17.45). The most common presentations were systemic illness (62.1%), pain (60.6%), urinary tract infections (54.5%) and an abdominal mass (39.4%); pyrexia was present in 53%. Biochemical abnormalities included anaemia (86.3%), thrombocytosis (80.3%) and hypomagnesemia (65.1%). There was an 83.3% concordance between intraoperative cultures and positive mid-stream urines. Index kidneys were significantly larger than the contralateral side (mean 1.32 cm; P = 0.002). Staging of XGP demonstrated extension beyond the kidney in 79% of kidneys. Computed tomography (CT) was performed in 11 cases (Summary figure). Dimercaptosuccinic acid (DMSA) scan showed 0-10% function in 90.47% of cases. Surgical procedures included nephrectomy (n = 63) and partial nephrectomy (n = 3). Perioperative complications included colonic resections (n = 5) and abscess formation in 18%.

CONCLUSIONS

This is the largest series to date of XGP in a paediatric cohort. XGP should be included in the differential diagnosis of all children presenting with perirenal or psoas abscesses, renal masses and/or non-functioning kidneys with/or without associated urolithiasis. Clinical awareness and a high index of suspicion is required to achieve the correct pre-operative diagnosis and appropriate management.

Early Progression of Xanthogranulomatous Pyelonephritis in Children Might Be Dependent on Vimentin Expression

BACKGROUND Xanthogranulomatous pyelonephritis (XP) is an extremely rare, severe, atypical form of chronic renal parenchymal inflammation accompanied by hydronephrosis and/or urolithiasis. The pathomechanism of XP is not yet fully understood. Microscopically, XP is indicated by the presence of multinucleated giant cells and lipid-laden macrophages, as well as inflammatory infiltration and intensive renal fibrosis. The lipid accumulation in kidney parenchyma may be secondary to the altered flow of low-density lipoprotein (LDL)-derived cholesterol particles inside the affected cells. Physiologically, the process of LDL-derived cholesterol transport from lysosomes to the sites of its esterification is dependent on vimentin, which is a molecule comprising the cytoskeleton in mesenchymal cells. CASE REPORT A 7-year old girl was hospitalized because of the finding of unexplained kidney lesions on an abdominal ultrasound examination (an enlarged and deformed collecting system of the right kidney with hyperechogenic, solid, staghorn lesions in the calyces). Three months earlier, the patient had experienced recurrent urinary tract infection. Based on the subsequent laboratory and imaging diagnostics, the final diagnosis of XP was established and the girl was qualified for right-sided nephrectomy Microscopic examination revealed numerous foci of granuloma formations with no evident exponents of dysplastic or neoplastic abnormalities. Significant CD68-positive cell infiltrations and scattered foam cells arranging the numerous foci of granuloma inflammation were noticed. Renal parenchyma, adjacent to granuloma lesions, presented a vimentin expression. CONCLUSIONS Vimentin expression in XP may confirm a focal character of chronic granuloma formation and may suggest the complexity of XP pathogenesis involving not only macrophage and fibroblast activation but also local lipid deregulation and fibrosis.

[Abdominal mass revealing xanthogranulomatous pyelonephritis in an infant]

Xanthogranulomatous pyelonephritis (XGP) is a chronic pyelonephritis observed in children and exceptionally in infants. Symptomatology is vague and may delay diagnosis and patient's management. Treatment is based on medical therapy but most often on surgery with poor renal prognosis. We report the case of a 15-month old infant with isolated mass in the left flank. He had no fever or alteration of general state and urine cultures were sterile. Radiological evaluation (renal ultrasound, uroscan and renal scintigraphy) highlighted left non-functioning kidney with "hydropyonephrosis" evoking the diagnosis of XGP. The indication for total nephrectomy by lombotomy was posed and definitive anatomo-pathological examination confirmed the diagnosis of diffuse XGP. This observation emphasizes the importance of suspect PXG in patients with renal mass or malformative uropathy with recurrent urinary tract infections whose treatment should be rigorous and codified.

Xanthogranulomatous pyelonephritis masquerading as a tumor in an infant

Xanthogranulomatous pyelonephritis (XGP) is an uncommon form of chronic pyelonephritis and a well recognized entity. It is rarely seen in children and neonates. The preoperative diagnosis is difficult and the etiology is still obscure. The condition is mostly diagnosed on nephrectomy specimen. The focal form mimicking neoplastic condition is rare. A case of XGP is reported here in an 8 month old child in which case nephrectomy was done with the clinical diagnosis of malignant renal tumor. Various modalities of preoperative diagnosis of this entity with conservative approach are also discussed.

Xanthogranulomatous Pyelonephritis Can Simulate a Complex Cyst: Case Description and Review of Literature

Xanthogranulomatous pyelonephritis is a rare and peculiar form of chronic pyelonephritis and is generally associated with renal lithiasis. Its incidence is higher in females. The peculiarity of this disease is that it requires a differential diagnosis, because it can often simulate dramatic pathologic conditions. In fact, in the literature are also described cases in association with squamous cell carcinoma of the kidney The radiologic clinical findings simulate renal masses, sometimes in association with caval thrombus. We describe a case of xanthogranulomatous pyelonephritis with radiologic aspects of a complex cyst of Bosniak class III in a man 40-year old.

Xanthogranulomatous pyelonephritis mimicking a renal cell carcinoma: a unique and challenging case

We describe an unusual case of xanthogranulomatous pyelonephritis (XGPN) in a 73-year-old woman diagnosed after a blunt abdominal trauma. This case is unique because of the atypical presentation, with absence of symptoms, normal laboratory exams, and unusual computed tomography and magnetic resonance imaging findings. The patient underwent radical nephrectomy because a renal cystic tumor was suspected. Only the histopathological findings suggested the final diagnosis of XGPN.

Xanthogranulomatous pyelonephritis in early infancy

Xanthogranulomatous pyelonephritis is a severe, atypical form of chronic renal parenchymal infection, which mimics neoplasia and other inflammatory renal parenchymal diseases. Although xanthogranulomatous pyelonephritis has characteristic findings on sonography and CT scan, a clinical diagnosis is seldom possible. Correct diagnosis is made on exploration, by the presence of dense adhesions to the surrounding tissue and presence of pus in the kidney, which is confirmed histopathologically by the presence of lipid laden foamy macrophages, accompanied by both chronic and acute phase inflammatory cells.

[Diffuse xanthogranulomatous pyelonephritis in infant]

We report a case of a renal mass in a 4-month boy, which occured during the assessment of a pelvi-calyceal dilatation diagnosed at 23 weeks of gestational age. There was no history of urinary infection, fever or weight loss. Physical examination revealed a mass of the left flank with significant flank tenderness. Laboratory test showed a biological inflammatory syndrome and urine culture was negative. Investigations including ultrasound and computed tomography scan were suggestive of diffuse xanthogranulomatous pyelonephritis with a non-functioning left kidney. Left total nephrectomy was performed through a lumbar incision with an extraperitoneal approach. The kidney was enlarged with a dilated pelvis containing pus upstream of a proximal ureteral atretic segment. Pathological examination of the kidney confirmed the diagnosis of diffuse xanthogranulomatous pyelonephritis. The boy remains well at 1 year follow-up. Xanthogranulomatous pyelonephritis is very rare in infants. It is an uncommon severe progressive renal infection resulting in destruction of renal parenchyma, histologically replaced by xanthomatous cells and granulomatous reaction. Pathogenesis of xanthogranulomatous pyelonephritis remains unclear. But it is well known that urinary tract obstruction and renal lithiasis are determining factors. It can occur in variant clinical forms but its symptoms remain non-specific. Curative treatment consists in nephrectomy and definitive diagnosis is made on histological examination of the kidney. This diagnosis should be discussed when a renal mass occurs in a context of malformative uropathy and xanthogranulomatous pyelonephritis have to be included in the differential diagnosis of renal mass in infants and children.

Xanthogranulomatous Pyelonephritis in a male child with renal vein thrombus extending into the inferior vena cava: a Case Report

Background

We present a case of Xanthogranulomatous pyelonephritis (XGPN) in a male child with renal vein thrombus extending into the inferior vena cava. This is a rare presentation. XGPN is a rare type of renal infection characterised by granulomatous inflammation with giant cells and foamy histiocytes. The peak incidence is in the sixth to seventh decade with a female predominance. XGPN is rare in children.

Case presentation

An 11 year old male child presented with a history of high grade fever and chills, right flank pain and progressive pyuria for two months. He had a history of vesical calculus for which he was operated four years back. In our case, a subcapsular right nephrectomy was performed. The surgical specimens were formalin fixed and paraffin embedded. The sections were stained with routine Hematoxylin & Eosin stain. Grossly; the kidney was enlarged with adherent capsule and thickening of the perinephric tissue. The pelvicalyceal system was dilated and was filled with a cast of pus. Histological evaluation revealed diffuse necrosis of the renal parenchyma and perinephric fat. Neutrophils, plasma cells, sheets of foamy macrophages and occasional multinucleate giant cells were seen. The renal vein was partially occluded by an inflammatory thrombus with fibrin, platelets and mixed inflammatory cells. The thrombus was focally adherent to the vein wall with organization.

Conclusions

The clinical presentation and the macroscopic aspect, together with the histological pattern, the cytological characteristics addressed the diagnosis towards XGPN with a vena caval thrombus. Our case illustrates that the diagnosis of XGPN should be considered even in paediatric age group when renal vein and vena caval thrombi are present.

Xanthogranulomatous pyelonephritis in pediatric patients: effect of surgical approach

OBJECTIVES

To review our experience with pediatric xanthogranulomatous pyelonephritis (XGPN) with special focus on surgical management.

METHODS

From 1983 to 2007, 6 pediatric patients were found to harbor XGPN. The demographic data, mode of presentation, clinical and radiologic findings, laboratory profile, preoperative diagnosis, operative findings, and pathologic diagnosis of the removed specimen were recorded.

RESULTS

The patients included 5 boys and 1 girl, with a mean age at presentation of 7.8 +/- 2 years. The symptoms included loin pain with or without anorexia or weight loss in all; however, a palpable mass was elicited in only 1 patient. All had pyuria on urinalysis, with positive cultures in 3. The 6 patients were anemic with normal kidney function. Abdominal ultrasonography revealed an enlarged kidney with multiple stones in 4 and a space-occupying lesion in 2 patients. Computed tomography was requested for 3 patients, and the findings raised the suspicion of Wilms tumor in 2. All 6 patients underwent nephrectomy. The lumbar approach was used for 3 patients with high complication rates. Laparoscopic nephrectomy was tried in 1 patient and was converted to open nephrectomy with a lumbar approach. The remaining 2 patients underwent exploration through a transperitoneal paramedian approach, with safer and easier surgical access. Pathologically, focal XGPN was diagnosed in only 1 patient, with the diffuse form diagnosed in 5 patients.

CONCLUSIONS

Magnifying the clinical awareness of XGPN in pediatric practice is fundamental to achieving the correct preoperative diagnosis. Nephrectomy through the paramedian transperitoneal approach is probably acceptable as the access route of choice, with a minimal complication rate.

Xanthogranulomatous pyelonephritis in children: diagnostic and therapeutic aspects

Xanthogranulomatous pyelonephritis (XGP) is a rare, chronic inflammatory disease of the kidneys. It is characterized by destruction of renal parenchyma and accumulation of lipid-laden foamy macrophages. Diffuse and focal forms are known. The condition is mainly observed in middle-aged women, and it is very rare in childhood. Of 32 nephrectomies carried out in children for various diseases in our hospital over the course of 2 years, there were two cases of diffuse XGP. In both cases, the preoperative diagnosis based on ultrasound findings was highly suggestive of XGP. We present the two cases and define the typical ultrasonographic signs for distinguishing XGP from other renal masses. The diagnostic and therapeutic management is discussed and an overview of the literature is given.

Xanthogranulomatous adrenalitis in a neonate: CT and US findings

We report a 46-day-old female infant with xanthogranulomatous adrenalitis. Ultrasonography showed a complex, solid-cystic right suprarenal mass with poorly defined margins. Colour flow Doppler revealed the solid portion of the mass to be vascular. CT demonstrated a heterogeneous cystic and solid mass with some contrast enhancement in the inferior part of the lesion. There was compression of the adjacent upper pole of the right kidney and the lateral aspect of the inferior vena cava. The mass was completely removed; histological examination revealed xanthogranulomatous adrenalitis. At the time of this report she remained well 3 years following surgery.

Xanthogranulomatous pyelonephritis infiltrating the liver

We report for the first time a patient with a caliceal diverticulum that was detected in early childhood, who in adolescence developed xanthogranulomatous pyelonephritis to the diverticulum and surrounding kidney and infiltrated to the liver. The condition was treated by nonradical organ-sparing surgery and prolonged antibiotic therapy.

Pediatric xanthogranulomatous pyelonephritis masquerading as complex renal mass

We present a case of focal xanthogranulomatous pyelonephritis (XGP) in a pediatric patient. This case illustrates the variable presentation of the entity and the difficulty in making a preoperative diagnosis. In contrast to the usual diffuse form of XGP, the focal form permits less radical treatment in cases such as this one. This case, however, did not exhibit any of the usual features of XGP reported in large series, making preoperative planning problematic.

[Imaging features of xanthogranulomatous pyelonephritis]

Pseudotumoral xanthogranulomatous pyelonephritis is a rare chronic renal infection. Preoperative diagnosis is difficult because of its non-specific presentation. The purpose of this retrospective review of 8 cases is to assess the value of different imaging techniques in the evaluation of this pathology. Six males and 2 females, aged 29 to 75 years were included. The right kidney was involved in 5 cases and the left kidney was involved in 3 cases. Involvement was upper polar in 2 cases and lower polar in 6 cases. A kidney stone was present in 3 cases. US showed a heterogeneous hypoechoic lesion in 3 cases, a homogeneous hypoechoic lesion in 3 cases, and isoechoic lesion in 1 case and a cystic lesion in 1 case. CT showed a focal solid lesion with peripheral enhancement in 4 cases and a cystic mass with peripheral enhancement in 3 cases. US features are non-specific. CT shows a non-specific renal mass, the presence of obstruction and demonstrates perirenal involvement. Preoperative MRI, not performed in our patient population, demonstrates specific changes in the perirenal fat that suggests the diagnosis. The diagnosis of pseudotumoral xanthogranulomatous pyelonephritis can be suspected on a constellation of clinical and laboratory findings combined with non-specific features on CT and US and specific MRI features of perirenal fat changes. Percutaneous biopsy may be needed in selected cases to confirm diagnosis.

CT imaging of mass-like renal lesions in children

Mass-like renal lesions in children occur in a diverse spectrum of conditions including benign and malignant neoplasm, infection, infarction, lymphatic malformation, and traumatic injury. Although mass-like renal lesions can sometimes be suspected on plain radiographs and evaluated with US in children, subsequent CT is usually performed for the confirmation of diagnosis and further characterization. The purpose of this pictorial essay was to review the CT imaging findings of both common and uncommon mass-like renal lesions in pediatric patients. Understanding the characteristic CT appearance of mass-like renal lesions in children enables an accurate diagnosis and optimizes patient management.

Xanthogranulomatous Pyelonephritis in Childhood: A Critical Analysis of 10 Cases and of the Literature

OBJECTIVES

To report our experience with 10 cases of pediatric xanthogranulomatous pyelonephritis and review the literature regarding this relatively uncommon disease.

METHODS

The records of 10 patients presenting to our institution with xanthogranulomatous pyelonephritis between 1996 and 2006 were examined. The mode of presentation, clinical and radiologic findings, blood count, blood chemistry, urine culture results, operative findings, and histologic findings of the affected kidney were recorded.

RESULTS

Staging was performed according to the classification of Malek and Elder. Through radiologic and operative investigations our patients were classified as Stage 1 (n = 1), Stage 2 (n = 6), and Stage 3 (n = 3). Simple nephrectomy was performed in all 10 patients.

CONCLUSIONS

Previously the diagnosis of xanthogranulomatous pyelonephritis was normally based on pathologic assessment, most commonly after nephrectomy. During the last decade, however, increasingly sensitive radiologic investigations (sonography, four-phase computed tomography, and magnetic resonance imaging) in combination with clinical suspicion have made its preoperative diagnosis possible. Surgical intervention still remains the cornerstone of treatment for this relatively uncommon disease.

Xanthogranulomatous pyelonephritis

Xanthogranulomatous pyelonephritis is a rare condition in children. A 7-year-old boy developed right flank pain and tenderness 1 month after an appendectomy. Abdominal computed tomography scan documented a right renal mass. A right nephrectomy was performed. The pathological report documents xanthogranulomatous pyelonephritis. He experienced an uneventful recovery. Xanthogranulomatous pyelonephritis should be included in the differential diagnosis of children with fever, weight loss, flank tenderness, and a renal mass.

[Xanthogranulomatous pyelonephritis in childhood. A case report]

Xanthogranulomatous pyelonephritis is an uncommon chronic inflammatory renal disorder. Most cases have been described in middle aged women and it is extremely rare in children. We report a case of a 4 year old girl who suffered from recurrent urinary tract infection and antibiotic therapy resistance. She had low growth-rate and palpable left renal mass on examination and was confirmed by radiological findings. We performed left kidney partial resection and then histological examination showed focal xanthogranulomatous pyelonephritis. The focal form of the disease may respond to antibiotic treatment although usually an enucleation or partial resection must be performed. In conclusion xanthogranulomatous pyelonephritis should be considered in the differential diagnosis of a renal mass and recurrent urinary tract infection in childhood.

Diffuse xanthogranulomatous pyelonephritis in a patient with myotonic dystrophy and cerebral palsy

Xanthogranulomatous pyelonephritis (XGP), a morphological and clinical variant of chronic pyelonephritis, is an uncommon disease in children. It is characterized by the destruction of the renal parenchyma and replacement by granulomatous tissue containing foamy lipid-laden macrophages and is classified into diffuse and focal XGP. We present a case of diffuse XGP in a child with myotonic dystrophy complicated by cerebral palsy and discuss the importance of correct diagnosis and preoperative management to reduce inflammation and improve malnutrition associated with the disease.

Ultrasonographic features of focal xanthogranulomatous pyelonephritis

OBJECTIVE

To analyze the ultrasonographic features of focal xanthogranulomatous pyelonephritis.

METHODS

Ultrasonographic features of 15 patients with pathologically proved focal xanthogranulomatous pyelonephritis were retrospectively analyzed by 2 radiologists who reached a consensus, in terms of the location, margin, size, and echo texture of the mass, associated calculi, lymphadenopathy, or local extension, in comparison with computed tomographic and clinical findings.

RESULTS

At ultrasonography, 12 (80%) of 15 masses were well circumscribed. The maximal sizes of the masses ranged from 2.5 to 5.8 (mean, 3.8) cm. Thirteen solid masses (87%) were hyperechoic (n = 7), hypoechoic (n = 4), or isoechoic (n = 4) to the renal cortex, and the preoperative diagnosis was either renal cell carcinoma (n = 11) or Wilms tumor (n = 2). The preoperative diagnosis of the other 2 cystic lesions (13%) was renal abscess. Renal calculi were found in 1 case, but lymphadenopathy or local extension was not depicted. Clinical inflammatory signs were found in 11 of 15 patients.

CONCLUSIONS

There were no specific ultrasonographic features that allow for the distinction between focal xanthogranulomatous pyelonephritis and renal tumors or abscesses. Focal xanthogranulomatous pyelonephritis should be considered when there are clinical signs of infection or inflammation and a focal solid mass is seen on ultrasonography.

Pediatric focal xanthogranulomatous pyelonephritis: dynamic contrast-enhanced MRI findings

Xanthogranulomatous pyelonephritis (XPN) is the result of chronic renal infection. It is very rare in childhood and the focal form, which is said to be more common in children, is often misdiagnosed as a renal tumor. We report a case of a focal XPN in a 14-year-old girl. The true preoperative diagnosis may be very hard in children especially in the focal form but it seems to be possible by the help of dynamic contrast-enhanced MRI.

Xanthogranulomatous pyelonephritis in childhood: a rare but important clinical entity

PURPOSE

Xanthogranulomatous pyelonephritis (XGPN) is extremely rare in children. The authors review their experience of this condition.

METHODS

Medical records were investigated to conduct a retrospective study of 4 patients with XGPN (3 boys, 1 girl; age range, 2 months to 7 years) at the authors' institute over the past 14 years.

RESULTS

Three of the 4 patients presented with fever of unknown origin and 1 with general fatigue. An abdominal mass was palpable in two cases at initial presentation. Although all patients had pyuria or hematuria, preoperative urine culture was positive in only 2 cases. Preoperative radiologic studies showed that 1 kidney was affected completely in 2 cases and affected partially in 2 cases. Preoperatively, the provisional diagnosis was XGPN in 3 cases, and Wilms' tumor in 1 case. Total nephrectomy was performed in 3 cases and enucleation in 1 case. XGPN was confirmed in all cases by histopathologic studies, but the underlying disease could be identified only in 1 case (cystinuria). All patients did well postoperatively and have had no further health problems over a mean follow-up period of 4.8 years.

CONCLUSIONS

XGPN should be considered when there is a history of recurrent or therapy-resistant pyelonephritis. Preoperative radiologic investigation is paramount for diagnosis, and nephrectomy is the treatment of choice, although partial resection or enucleation are adequate for partially affected kidneys.