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Xanthogranulomatous pyelonephritis, the gatekeeper's dilemma: a contemporary look at an old problem
E A Nataluk1, D L McCullough, E O Scharling
1Department of Urology, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina.
Insights
Computed tomography (CT) scans accurately diagnose xanthogranulomatous pyelonephritis (XGP), a rare kidney infection. This imaging is recommended for suspected XGP cases, proving most effective for diagnosis before surgery.
Area of Science:
- Radiology
- Urology
- Pathology
Background:
- Xanthogranulomatous pyelonephritis (XGP) is a rare, chronic bacterial infection of the kidney.
- It is characterized by suppurative destruction of the renal parenchyma.
Purpose of the Study:
- To review 12 patients diagnosed with xanthogranulomatous pyelonephritis (XGP).
- To determine if computed tomography (CT) is the optimal imaging modality for diagnosing XGP.
Main Methods:
- Retrospective chart review of patients with XGP over a 12-year period.
- Analysis of clinical presentations, laboratory findings, and imaging results.
Main Results:
- Computed tomography (CT) scans correctly diagnosed XGP in 90% of evaluated patients prior to nephrectomy.
- Common symptoms included flank pain (64%), leukocytosis (73%), and anemia (82%).
- Ureteropelvic junction or staghorn stones were present in 75% of patients; Proteus was the most common organism.
Conclusions:
- CT scan is the imaging procedure of choice for evaluating suspected cases of xanthogranulomatous pyelonephritis (XGP).
- CT provides the most accurate diagnosis for this condition.
Objectives:
To review 12 patients with a clinicopathogenic diagnosis of xanthogranulomatous pyelonephritis (XGP) and to determine if a computed tomography (CT) scan is the imaging procedure of choice for diagnosis.
Methods:
A retrospective review, over the last 12 years, of patients with XGP at our institution.
Results:
Nine of 10 patients (90%) who were evaluated by CT scan had the correct diagnosis made prior to nephrectomy. The most common presenting symptoms and signs were flank pain (64%), leukocytosis (73%), and anemia (82%). Seventy-five percent of the patients had a ureteropelvic junction stone or a staghorn stone in the affected kidney at the time of clinical presentation. Proteus was the most common organism cultured.
Conclusions:
After reviewing the clinical features of these 12 patients, we recommended CT scan to evaluate the patient in whom clinical suspicion of XGP is entertained. CT has proven to be the most accurate imaging study to evaluate this disease.