Xanthogranulomatous pyelonephritis in children and adults--an 8 year study

20 cases of Xanthogranulomatous Pyelonephritis (XPN) were encountered over an 8 year period, constituting 0.4 percent of the total of 47,370 surgical biopsies, 10 percent of the total of 188 nephrectomy specimens removed for various reasons and 35 percent of the nephrectomy specimens associated with chronic pyelonephritis. This is the largest single series, reported in Indian literature. 16 patients were adults and 4 were children, thus 25 percent of our cases were children, a significantly high proportion. Our youngest patient a 5 1/2 month old male, is to the best of our knowledge, the youngest case reported from India. Males predominated in our series, the M:F ratio being 3:1, this contrasts with western literature in which there is a definite female preponderance. The common presenting symptoms were lumbar pain, fever and palpable non-functioning kidney. 4 cases were complicated by cutaneous sinuses. There was a slight predominance of affectation of the left side over the right side. On gross examination, diffuse lesions were commoner than focal lesions and were seen in children as well. An accurate pre-operative diagnosis was made in only 2 cases, in the rest, the diagnosis was either tuberculosis or pyonephrosis. Thus XPN is quite frequently seen in the adult Indian population and is not as rare in children, as it was once thought to be.