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Xanthogranulomatous pyelonephritis in children
Insights
Xanthogranulomatous pyelonephritis in children may present similarly to chronic pyelonephritis. Factors like malnutrition and kidney stones may influence this presentation in pediatric cases.
Area of Science:
- Pediatric Nephrology
- Renal Pathology
- Infectious Diseases
Background:
- Xanthogranulomatous pyelonephritis (XGP) is typically seen in adult women and presents as a renal mass.
- An increasing number of pediatric XGP cases suggest different disease characteristics compared to adults.
- The distinction between XGP and chronic pyelonephritis in children requires further investigation.
Purpose of the Study:
- To determine if XGP in children is a distinct entity from chronic pyelonephritis.
- To compare pediatric XGP cases with adult XGP and pediatric chronic pyelonephritis.
Main Methods:
- Retrospective review of 39 pediatric cases undergoing nephrectomy for chronic or xanthogranulomatous pyelonephritis.
- Comparison of pediatric XGP cases with literature data on adult XGP and local pediatric chronic pyelonephritis cases.
- Analysis of clinical presentation, demographic data, and microbiological findings.
Main Results:
- Demographics and left kidney involvement were similar between pediatric XGP and chronic pyelonephritis groups.
- Severe malnutrition, urolithiasis, reno-cutaneous fistula, and negative urine cultures were more frequent in pediatric XGP.
- Escherichia coli was the most common microorganism in both groups; all pediatric XGP cases were diffuse.
Conclusions:
- Pediatric XGP may not be as distinct from chronic pyelonephritis as in adults.
- Impaired immune response secondary to malnutrition and the presence of urolithiasis may contribute to XGP development in children.
- Further research is needed to elucidate the specific pathogenesis of XGP in the pediatric population.
Abstract:
Xanthogranulomatous pyelonephritis usually occurs in women 50 to 60 years old, and has the distinct clinical presentation suggestive of a renal mass. Since 1963 an increasing number of children with xanthogranulomatous pyelonephritis have been reported in the literature, with data suggesting that the characteristics of the disease are different from those in adults. We compared our children with xanthogranulomatous pyelonephritis to adults who had been described in the literature and to our cases of chronic pyelonephritis to determine whether xanthogranulomatous pyelonephritis in children is an entity as clearly different from chronic pyelonephritis as it is in adults. Twenty-one cases were eliminated from the study because of incomplete charts. We found 39 cases in which nephrectomy had been done for an anatomical diagnosis of chronic or xanthogranulomatous (8) pyelonephritis. Average age at presentation, duration of clinical course and sex distribution were similar in both groups. The left kidney was involved more often in both groups. Severe malnutrition, urolithiasis, reno-cutaneous fistula and negative urine cultures were more frequent in cases of xanthogranulomatous pyelonephritis, while obstructive nonlithiasic uropathy occurred more often in cases of chronic pyelonephritis. Microorganisms were similar in both groups and Escherichia coli was isolated most frequently. All cases of xanthogranulomatous pyelonephritis were of the diffuse type with areas corresponding to all histological stages. Our study suggests that perhaps in children xanthogranulomatous pyelonephritis occurs the same as chronic pyelonephritis, and is determined possibly by an affected immune response secondary to malnutrition and by the presence of urolithiasis.