Xanthogranulomatous Pyelonephritis

Xanthogranulomatous pyelonephritis is a chronic destructive granulomatous inflammation of the kidney. This pathology was firstly described in 1916 and a small number of patient series were reported in the literature. In this study, we aimed to report the patients with xanthogranulomatous pyelonephritis in our nephrectomy cases.

The patients who underwent nephrectomy and were diagnosed with xanthogranulomatous pyelonephritis in our hospital database were reviewed retrospectively. Preoperative laboratory results, radiological imaging findings, patients' age and history of predisposing diseases were recorded.

A total of 13 cases of xanthogranulomatous pyelonephritis treated in our hospital from January 2003 to December 2015 were included in the study, consisting of 7 male and 6 female patients with a mean age of 56 ± 16.09 years. In urine analyse, pyuria was positive in 6 patients (46.15%) and leukocytosis was detected in one patient (7.7%). The disease site was the right kidney in 4 patients (30.7%) and the left kidney in 9 patients (69.23%). Radiological findings of the patients were pyonephrosis, renal ectasia, pyelonephritis, hydronephrosis, renal tumor, xanthogranulomatous pyelonephritis and non-functioning kidney with renal calculi. All patients were treated by open surgical techniques and perioperative and postoperative complications did not occur. Partial and radical nephrectomy was performed in one patient and the other patients were treated with simple nephrectomy.

Xanthogranulomatous pyelonephritis is an uncommon histologic variant of the kidney for patients who are surgically treated for pyelonephritis. Early diagnosis and treatment is very important for decreasing morbidity and mortality. Although radical surgery is the main treatment of choice for patients with diffuse xanthogranulomatous pyelonephritis, nephron sparing surgery is an alternative for patients who have the focal form, if technically possible.