Minerva urologica e nefrologica = The Italian journal of urology and nephrology · 2000
[Xanthogranulomatous pyelonephritis. Our experience and review of the literature].
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MattaceRaso D, Autorino R, Schiavo M, D'Armiento M
Аннотация
BACKGROUND: Ten cases of xanthogranulomatous pyelonephritis (XGP) with diagnostic and therapeutic observation are described and other experiences reported in the literature are analyzed.
METHODS: The clinical, laboratory and radiological features of 10 patients who had undergone nephrectomy in our Istitute, between October 1993 and March 2000, with a postoperative pathological diagnosis of XGP have been retrospectively re-evaluated.
RESULTS: The most frequent symptom was flank pain. All the patients presented leucocytosis. Urine culture was positive for Proteus Mirabilis in four patients (40%) and for E. Coli in three (30%). In all the patients an ultrasound scan and urography were performed, six patients (60%) had undergone a CT scan and two of them (20%) a MRI. In six patients (60%) urinary lithiasis was associated and it was ramified in four of them (40%). The disease was always unilateral, affecting the right kidney in six cases and the left one in the other four. In three cases (30%) it presented in the focal form. The treatment was always surgical and it consisted of nephrectomy; a conservative surgical approach was used in two cases (20%). At the follow-up 4 patients (40%) showed recurrent urinary tract infections. None presented relapse.
CONCLUSIONS: XGP is an uncommon chronic inflammatory disease, often associated with urinary tract infections and/or urolithiasis. The clinical presentation is nonspecific so that differential diagnosis with other kidney diseases becomes difficult. A CT scan can be helpful in formulating diagnosis. The treatment is surgical and it consists of a nephrectomy, while a conservative approach can be reserved in some cases for the focal form. Cases treated with antibotics have been described.
METHODS: The clinical, laboratory and radiological features of 10 patients who had undergone nephrectomy in our Istitute, between October 1993 and March 2000, with a postoperative pathological diagnosis of XGP have been retrospectively re-evaluated.
RESULTS: The most frequent symptom was flank pain. All the patients presented leucocytosis. Urine culture was positive for Proteus Mirabilis in four patients (40%) and for E. Coli in three (30%). In all the patients an ultrasound scan and urography were performed, six patients (60%) had undergone a CT scan and two of them (20%) a MRI. In six patients (60%) urinary lithiasis was associated and it was ramified in four of them (40%). The disease was always unilateral, affecting the right kidney in six cases and the left one in the other four. In three cases (30%) it presented in the focal form. The treatment was always surgical and it consisted of nephrectomy; a conservative surgical approach was used in two cases (20%). At the follow-up 4 patients (40%) showed recurrent urinary tract infections. None presented relapse.
CONCLUSIONS: XGP is an uncommon chronic inflammatory disease, often associated with urinary tract infections and/or urolithiasis. The clinical presentation is nonspecific so that differential diagnosis with other kidney diseases becomes difficult. A CT scan can be helpful in formulating diagnosis. The treatment is surgical and it consists of a nephrectomy, while a conservative approach can be reserved in some cases for the focal form. Cases treated with antibotics have been described.