Asymptomatic Urolithiasis Complicated by Nephrocutaneous Fistula

Asymptomatic spontaneous nephrocutaneous fistula is a rare and severe complication of chronic urolithiasis. We report a case of 56-year-old woman with a nephrocutaneous fistula (NFC) which developed from a superinfected urinoma following calyceal rupture due to an obstructing calculus in the left ureter. The patient was clinically asymptomatic and came to the emergency department for a painless left flank fluctuating mass. This urinoma was superinfected, with a delayed development of renal abscesses and perirenal phlegmon found on contrast-enhanced uro-computed tomography (CT), responsible for left renal vein thrombophlebitis and left psoas abscess. Thereafter, a 99 mTc dimercaptosuccinic acid (DMSA) scintigraphy revealed a nonfunctional left kidney, leading to the decision of left nephrectomy. Chronic urolithiasis complications are rare and only few cases are reported in medical literature. A systematic medical approach helped selecting the best imaging modality to help diagnosis and treatment. Indeed, uro-CT scan and renal scintigraphy with 99 mTc-DMSA are the most sensitive imaging modalities to investigate morphological and functional urinary tract consequences of NFC, secondary to chronic urolithiasis.

Xanthogranulomatous pyelonephritis: a retrospective review of 16 cases

Purpose

Xanthogranulomatous pyelonephritis is an uncommon disorder of unknown etiology that is characterized by extensive destruction of the involved kidney. It is being increasingly recognized as an important cause of renal morbidity around the world.

Materials and Methods

This retrospective study was undertaken to review the xanthogranulomatous pyelonephritis cases presented at our tertiary care referral center in Bangalore, India.

Results

A total of 16 biopsy-proven cases of xanthogranulomatous pyelonephritis from October 2007 to March 2010 treated at our institute were included in the study. There were 10 females and 6 males with a mean age of 51.5 years. Flank pain was the most common presenting symptom followed by fever. All patients had unilateral disease and underwent total nephrectomy of the affected nonfunctional kidney.

Conclusions

Xanthogranulomatous pyelonephritis is a chronic and unusual infectious inflammatory condition involving the renal parenchyma. The definite treatment is nephrectomy. Early identification and prompt treatment of this relatively benign and uncommon condition is important to minimize morbidity and mortality.