Xanthogranulomatous pyelonephritis (XGP) is an unusual form of chronic pyelonephritis in which the renal parenchyma is destroyed and replaced by lipid-laden foamy macrophages. It usually affects middle-aged women with a history of recurrent urinary tract infection, diabetes, or kidney stones. The inflammatory process is usually diffuse and can extend beyond the kidney. The rare focal forms may simulate primary renal tumours. The preoperative imaging diagnosis may be difficult. We reported five cases of XGP, The findings of ours were recorded including kidney size, shape, contour, the echogenecity of the renal parenchyma, the internal echoes of the dilate collecting system, the presence of perinephric fluid accumulation and obstruction. One of the 5 cases was a male patient, and the other four were female, with a mean age of 53 years. He affected kidneys of the 5 cases swelled in different degrees, and one of them was found with line-like anechoic fluid. Among the 5 cases, one kidney appeared as diffusely reducing of the parenchyma echogenicity, multiple hypoechoic areas, disappearance of corticomedullary differentiation and multiple hyperecho with shadow. A round cystic anechoic lesion was found in one kidney, with internal punctate echo and peripheral fluid. Ultrasonographic finding of 1 case was extremely hypoechoic lesion on the left kidney, protruding from the outline of the kidney, with the partial renal capsule discontinuous, the less clear boundary, and a little blood flow in it. Ultrasonographic demonstration of 2 cases was mild dilatation of the collecting system with irregular wall thickening and internal hypoechogenicity, and 1 case was solid lesion with less clear boundary to the pelvic wall and a small amount of blood flow signal, the another 1 case was showed floccule without internal blood flow. Three cases were caused by chronic obstruction verified by operation, of which one was staghorn calculi, one was poorly differentiated squamous cell carcinoma in the middle part of the ureter, and one was inflammatory stricture of upper ureteral. Through analysis of the above five cases and review of related literature, we explored diagnoses and management of the patients with XGP. Xanthogranulomatous pyelonephritis (XGP) is a rare chronic variant of pyelonephritis characterized by destruction of the renal parenchyma. Combining ultrasonographic features of XGP with clinical recurrent urinary infection and chronic obstruction, XGP can be included in the differentiation. The diagnosis of XGP suspected by ultrasound can be clarified by CT, MRI, contrast-enhanced ultrasound.
Female ; Humans ; Kidney/pathology* ; Male ; Middle Aged ; Pyelonephritis/surgery* ; Pyelonephritis, Xanthogranulomatous/surgery* ; Ultrasonography

PURPOSE: Retroperitoneal laparoscopic nephrectomy for inflammatory renal conditions remains technically challenging, but can prevent intraperitoneal contamination by inflammatory or pathologic materials and decrease the risk of visceral injury or peritoneal morbidity. We evaluated retroperitoneal laparoscopic nephrectomy in terms of feasibility, safety, and efficacy in inflammatory renal disease. MATERIALS AND METHODS: Between March 2003 and June 2006, retroperitoneal laparoscopic nephrectomy was performed in 39 patients with benign renal disease. Of the 39 patients, 18(group 1) had inflammatory renal diseases with perinephric stranding on CT, which was confirmed as an adhesion during surgery. The remaining 21 patients(group 2) had nonfunctioning kidneys without significant inflammation. Intraoperative and postoperative clinical parameters were analyzed and compared between the 2 groups. RESULTS: Retroperitoneal laparoscopic nephrectomy was successful in all 39 patients without conversion to open surgery. Group 1 included tuberculous pyelonephritic kidney(n=11), xanthogranulomatous pyelonephritis (n=3), pyonephrosis(n=2) and renal abscess(n=2). Group 2 included chronic pyelonephritis(n=12), ureteropelvic junction obstruction(UPJ) stricture(n=6), and cystic disease(n=3). The mean operating time and the mean estimated blood loss were significantly different between the 2 groups(p<0.001). The mean time to oral intake and ambulation, and the mean duration of hospitalization were not different between the 2 groups. There were 1 major and 2 minor complications in group 1 and 2 minor complications in group 2. CONCLUSIONS: Retroperitoneal laparoscopic nephrectomy is a feasible and safe treatment modality in inflammatory renal diseases as well as other benign renal diseases.
Conversion to Open Surgery ; Hospitalization ; Humans ; Inflammation ; Kidney ; Laparoscopy ; Nephrectomy ; Pyelonephritis, Xanthogranulomatous ; Walking

PURPOSE: Xanthogranulomatous pyelonephritis (XGP) is rare among children. In most cases, XGP is diffusely or focally enlarged, mimicking the neoplastic process. The aim of this study was to examine clinical characteristics and outcomes of Korean children with XGP. MATERIALS AND METHODS: Fourteen children (9 boys, 5 girls) with XGP were reviewed retrospectively. The cohort included 2 children managed at our institution and 12 children reported in the Korean literature. The patients' records were reviewed with respect to age at diagnosis, clinical presentation, management method, and other characteristic features. RESULTS: The mean age was 79.4+/-66.5 months (range 1-168 months). Common clinical presentations included fever (85.7%), abdominal pain (57.1%), and palpable mass (28.6%). Laboratory abnormalities included leukocytosis (57.1%), anemia (57.1%), and pyuria (57.1%). The types of XGP that were diagnosed based on preoperative radiologic studies included the focal form in 9 children and the diffuse form in 5. Thirteen children underwent nephrectomy, and 1 child received conservative medical therapy. CONCLUSION: The possibility of XGP should be considered if a child is diagnosed with a renal mass, especially if it is a small renal mass associated with fever, leukocytosis, or stone. Nephrectomy is the treatment of choice for the diffuse form, whereas partial nephrectomy or conservative medical therapy may be indicated to manage focal XGP.
Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Korea ; Male ; Nephrectomy ; Pyelonephritis, Xanthogranulomatous/*diagnosis/drug therapy/surgery ; Retrospective Studies