Xanthogranulomatous pyelonephritis in adults: clinical and radiological findings in diffuse and focal forms
Introduction
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. Although the features of XGP on ultrasonography (US), computed tomography (CT), or magnetic resonance imaging (MRI)1, 2 have been described, the findings provided by these three methods used in combination have not been reported. The purpose of this retrospective study was to describe the clinical, US, CT, and MRI findings in 13 patients with histologically documented XGP.
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Materials and methods
We identified 13 cases of XGP documented by histopathological examination of nephrectomy specimens at our hospital between January 1993 and December 2005. The patients were 10 female and three male Caucasians with a mean age of 55.2 years (range 30–87 years). One woman was pregnant at the time of the diagnosis. The following data were abstracted from the medical records: symptoms, history, physical findings, laboratory test results, urine culture results, findings at surgery, and histological
Symptoms and signs
In all patients, a single kidney was involved, the right kidney in seven cases and the left kidney in six. Symptom duration ranged from 2 days to 5 years (mean 6.5 months). The most common complaints were fever (n = 9), anorexia with weight loss (n = 9), and flank pain (n = 7). Symptoms suggesting urinary tract infection (urgency, frequency, and dysuria) were reported by five patients. A mass was palpable in the flank in two patients. Pyuria was not a feature. In two patients, there was a fistulous
Discussion
XGP is a rare form of low-grade chronic renal infection characterized by progressive destruction of the renal parenchyma. The cause is unknown. Women are predominantly affected (in a 3:1 ratio), usually in mid-life (50–60 years) and after a long history of recurrent urinary tract infection or urinary stones.3 Involvement of both kidneys is exceedingly rare.4 XGP is diffuse in 90% of cases. Focal XGP can simulate a tumour. Gross examination shows an enlarged kidney with an irregular surface. The
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