Case Report- Xanthogranulomatous pyelonephritis
Hsin-Cheng Chu, Wei-Tang Kao
Department of Urology, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan
Xanthogranulomatous pyelonephritis (XPN) is an unusual variant of chronic pyelonephritis. Most cases occur in the setting of obstruction due to infected renal stones. Affected patients usually have massive destruction of the kidney due to granulomatous tissue containing lipid-laden macrophages; the appearance may be confused with renal malignancy.
A 86 year-old female with underlying history of type 2 diabetes mellitus, hypertension, and chronic kidney disease, presented with intermittent fever for 1 day. According to the patient, refractory urinary tract infection were treated with antibiotics, but in vain. CT was done, and showed right chronic pyelonephritis with renal stone (Figure 1.). Empiric antibiotics were given and fever curve went down smoothly. Xanthogranulomatous pyelonephritis with non-function kidney was impressed, and right laparoscopic radical nephrectomy was arranged. Grossly, the calyx of kidney was filled with grayish granulomatous pus (Figure 2-4.). The patient was discharged under stable condition.
Xanthogranulomatous pyelonephritis is almost always unilateral and is most frequently confused clinically and radiographically with renal carcinoma. Xanthogranulomatous pyelonephritis is treated with partial or full nephrectomy following an initial course of antibiotics to control the local infection.