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

Xanthogranulomatous pyelonephritis (XP) is an uncommon, chronic, destructive, granulomatous disease of the renal parenchyma. The condition is generally associated with long-term urinary tract obstruction and infection, although the precise etiology of disease remains unknown. The condition often mimics neoplastic and inflammatory diseases, and XP associated with actinomycosis is extremely uncommon. A 60 year-old male was admitted complaining of abdominal pain and weight loss. His radiological findings were suggestive of metastatic kidney cancer, and we performed radical laparoscopic nephrectomy and mesenterectomy for diagnostic purposes. Pathologically, actinomycosis combined with XP was evident. We report here a rare case of XP associated with actinomycosis.
Abdominal Pain ; Actinomycosis* ; Humans ; Kidney Neoplasms* ; Kidney* ; Male ; Nephrectomy ; Pyelonephritis ; Pyelonephritis, Xanthogranulomatous* ; Urinary Tract ; Weight Loss

Isolated renal mucormycosis is rarely identified and has been described in only a handful of cases. We hereby report a case of isolated renal mucormycosis with an atypical presentation in an immunocompetent patient with no identifiable risk factors. A 30-year-old nondiabetic male presented with a poorly functioning right kidney with minimal constitutional symptoms. The patient underwent a right simple nephrectomy. Histopathology revealed necrotizing xanthogranulomatous pyelonephritis with mucormycosis. The postoperative period was uneventful and the patient was managed without any antifungal administration. We hereby emphasize that renal mucormycosis can affect immunocompetent healthy adults without any previously known risk factors and that asymptomatic patients with no evidence of fungemia or disseminated disease can be managed without administration of intravenous amphotericin.
Adult ; Amphotericin B ; Fungemia ; Humans ; Immunocompetence ; Kidney ; Male ; Mucormycosis ; Nephrectomy ; Postoperative Period ; Pyelonephritis, Xanthogranulomatous ; Risk Factors ; Urinary Tract Infections

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

BACKGROUND/AIMS: Because preoperative diagnosis of xanthogranulomatous pyelonephritis (XGP) is difficult, due to its similarities to other renal diseases, the diagnosis is made postoperatively in most cases. The purpose of this study was to describe the clinical findings in 11 patients with histologically documented XGP. METHODS: We retrospectively reviewed the characteristics, laboratory and radiological findings, preoperative diagnoses and operative methods of 11 patients with XGP, who underwent a surgical procedure or percutaneous renal biopsy. RESULTS: Among eleven patients, nine had flank pain and six had anemia. Preoperatively, three patients were diagnosed as XGP, two with renal cell carcinoma, two with renal tuberculosis, one with renal abscess, one with perirenal abscess, one with renal staghorn calculi with non-functioning kidney, and one with pyelonephrosis. On the basis of the computed tomography (CT) features, the diffuse or global forms (70.0%) were more common than the localized or focal forms (30.0%). One patient diagnosed with renal cell carcinoma preoperatively was diagnosed as XGP through an intraoperative frozen section renal tissue biopsy and underwent partial nephrectomy. One patient diagnosed as focal XGP underwent percutaneous biopsy of the renal mass, which confirmed the diagnosis. This patient received treatment with only antibiotic therapy. CONCLUSIONS: CT can be considered the preferred diagnostic tool for the evaluation of XGP; however, percutaneous renal biopsy seems to be valuable in selected cases for differential diagnosis of renal malignancy.
Abscess ; Anemia ; Anti-Bacterial Agents ; Biopsy ; Calculi ; Carcinoma, Renal Cell ; Diagnosis, Differential ; Flank Pain ; Frozen Sections ; Humans ; Kidney ; Nephrectomy ; Pyelonephritis, Xanthogranulomatous ; Retrospective Studies ; Tuberculosis, Renal

PURPOSE: Xanthogranulomatous pyelonephritis is an uncommon disorder of unknown etiology that is characterized by extensive destruction of the involved kidney. It is being increasingly recognized as an important cause of renal morbidity around the world. MATERIALS AND METHODS: This retrospective study was undertaken to review the xanthogranulomatous pyelonephritis cases presented at our tertiary care referral center in Bangalore, India. RESULTS: A total of 16 biopsy-proven cases of xanthogranulomatous pyelonephritis from October 2007 to March 2010 treated at our institute were included in the study. There were 10 females and 6 males with a mean age of 51.5 years. Flank pain was the most common presenting symptom followed by fever. All patients had unilateral disease and underwent total nephrectomy of the affected nonfunctional kidney. CONCLUSIONS: Xanthogranulomatous pyelonephritis is a chronic and unusual infectious inflammatory condition involving the renal parenchyma. The definite treatment is nephrectomy. Early identification and prompt treatment of this relatively benign and uncommon condition is important to minimize morbidity and mortality.
Female ; Fever ; Flank Pain ; Humans ; Kidney ; Male ; Nephrectomy ; Pyelonephritis ; Pyelonephritis, Xanthogranulomatous ; Referral and Consultation ; Retrospective Studies ; Tertiary Healthcare

Xanthogranulomatous pyelonephritis is an uncommon chronic renal infection, which is usually found on middle-aged women and is rare in infant. Sometimes it forms focal mass like lesion of kidney with pathologically characteristic lipid-laden macrophage. A 1-month female infant was admitted for fever and moaning sound. On work-up of urinary tract infection, abdomen ultrasonography and computed tomography revealed a large mass on the upper portion of right kidney and PET/CT showed homogeneously increased 18F-FDG uptake. The radical nephrectomy of right kidney was performed and histology revealed a focal xanthogranulomatous pyelonephritis. To our knowledge, this is the first report presenting the finding of 18F-FDG PET/CT in the childhood xanthogranulomatous pyelonephritis.
Abdomen ; Female ; Fever ; Fluorodeoxyglucose F18 ; Humans ; Infant ; Kidney ; Macrophages ; Nephrectomy ; Pyelonephritis, Xanthogranulomatous ; Urinary Tract Infections

Urachal xanthogranuloma is an extremely rare disease. A 23-year-old man presented with severe lower abdominal pain and voiding frequency. Computed tomography revealed a urachal mass with bladder invasion, which was suspected to be a urachal carcinoma or abscess. Laparoscopic urachal resection was performed with a minimal incision. Histopathologic examination identified the mass as a urachal xanthogranuloma.
Abdominal Pain ; Abscess ; Humans ; Laparoscopy ; Pyelonephritis, Xanthogranulomatous ; Rare Diseases ; Urachal Cyst ; Urinary Bladder ; Urinary Bladder Neoplasms ; Young Adult

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

Fistula formation between the upper urinary tract and cutaneous tissue is an uncommon complication in urogenital disease. Xanthogranulomatous pyelonephritis(XGP) is a severe, chronic infection of the renal parenchyma that is often associated with calculi and obstruction. We present a rare case of XGP with a nephrocutaneous fistula.
Calculi ; Fistula ; Pyelonephritis, Xanthogranulomatous ; Urinary Tract