Xanthogranulomatous Pyelonephritis in the Tropics

Area of Science:

• Nephrology
• Pathology
• Urology

Background:

• Xanthogranulomatous pyelonephritis (XGP) is a rare, severe inflammatory kidney disease.
• It presents challenges in differentiating from renal cell carcinoma and other conditions.
• Histological examination post-nephrectomy is typically required for definitive diagnosis.

Purpose of the Study:

• To analyze the clinicopathological features of Xanthogranulomatous pyelonephritis.
• To highlight diagnostic challenges and the importance of histopathology.
• To evaluate the spectrum of associated pathologies found in XGP specimens.

Main Methods:

• Retrospective analysis of 55 nephrectomy specimens diagnosed with XGP.
• Review of clinical, laboratory, and radiological data from the Hospital Information System.
• Gross and microscopic pathological findings were meticulously examined.

Main Results:

• The study included 55 patients (age 6-73 years), with slightly higher incidence in the left kidney.
• Common symptoms included flank pain, recurrent UTIs, fever, and hydronephrosis; renal/ureteric stones were present in 49 cases.
• Histopathology confirmed XGP with varying associated conditions, including urothelial carcinoma in one case. Foamy histiocytes were a key microscopic finding.

Conclusions:

• Xanthogranulomatous pyelonephritis frequently mimics renal malignancy clinically and radiologically.
• Accurate histopathological diagnosis is essential to prevent overtreatment and ensure appropriate patient management.
• Increased awareness of XGP's clinicopathological spectrum can improve diagnostic accuracy and reduce radical surgeries.