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Xanthogranulomatous pyelonephritis: our experience with review of published reports

Udai S Dwivedi1, Neeraj K Goyal, Vaibhav Saxena

  • 1Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India. usd12@sify.co.in

ANZ Journal of Surgery
|October 24, 2006
PubMed
Abstract

Insights

Xanthogranulomatous pyelonephritis (XGP) is a rare kidney infection often linked to obstruction and stones. Early diagnosis is crucial to prevent kidney damage, as XGP can mimic tumors and other infections.

Area of Science:

  • Nephrology
  • Urology
  • Pathology

Background:

  • Xanthogranulomatous pyelonephritis (XGP) is a rare, chronic destructive inflammation of the kidney.
  • It is often associated with urinary tract obstruction, infection, and renal calculi.
  • Differentiating XGP from renal tumors preoperatively can be challenging.

Purpose of the Study:

  • To analyze cases of xanthogranulomatous pyelonephritis.
  • To review published reports on XGP.
  • To understand the clinical presentation, diagnosis, and management of XGP.

Main Methods:

  • Retrospective review of nephrectomy specimens from February 1995 to January 2006.
  • Analysis of 26 identified cases of XGP.
  • Compilation of patient data including symptoms, lab findings, imaging, and preoperative diagnosis; all cases underwent open nephrectomy.

Main Results:

  • The study included 26 patients (age 6-65, male:female ratio 1.6:1).
  • Common symptoms included fever (22), flank pain (21), and loin mass (18).
  • All affected kidneys showed hydronephrosis/pyonephrosis, renal calculi (10-42 mm), and compromised function; 13 had contralateral compensatory hypertrophy. Associated psoas abscess (1) and tuberculosis (1) were noted.

Conclusions:

  • Xanthogranulomatous pyelonephritis is a rare condition associated with obstruction, stones, and urinary tract infection.
  • Late presentation results in significant renal parenchyma loss.
  • Nephrectomy and antibiotics are the recommended treatment, as preoperative differentiation from renal tumors, pyonephrosis, or lymphoma is difficult.

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