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Xanthogranulomatous Pyelonephritis in Peritoneal Dialysis
Javier Burgos Martín1, Marina Almenara Tejederas1, Fabiola Alonso García1
1Nephrology, Hospital Universitario Virgen Macarena, Seville, Spain.
Case Reports in Nephrology and Dialysis
|July 17, 2024
Summary
Xanthogranulomatous pyelonephritis (XGP) is rare. In this case, XGP was diagnosed in a patient undergoing peritoneal dialysis (PD), highlighting the diagnostic challenges in PD patients with systemic inflammation.
Area of Science:
- Nephrology
- Pathology
Background:
- Xanthogranulomatous pyelonephritis (XGP) is a rare, destructive inflammatory kidney disease often linked to infection and urinary obstruction.
- Peritoneal dialysis (PD) patients often have a systemic inflammatory state due to uremic toxins, cytokine dysregulation, and dialysis-related factors.
Observation:
- A 74-year-old woman on PD for stage 5D chronic kidney disease presented with a 3-month history of progressive asthenia and elevated inflammatory markers.
- Despite negative urine and peritoneal fluid cultures, imaging revealed bilateral staghorn calculi, right hydronephrosis, and cortical thinning, raising suspicion for XGP.
Findings:
- A right nephrectomy was performed, and the anatomopathological study confirmed Xanthogranulomatous pyelonephritis.
- The patient was transitioned to hemodialysis prior to surgery and showed significant clinical and analytical improvement post-operatively.
Implications:
- The systemic inflammation and infection risk in PD patients can obscure the diagnosis of XGP.
- This case represents the first reported instance of XGP in a patient undergoing peritoneal dialysis, emphasizing the need for heightened diagnostic vigilance.
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