Xanthogranulomatous

Pyelonephritis
By
Shereen Hanafi Hassan
 Overview
Its unusual suppurative granulomatous reaction to
chronic renal infection.
Often occurs with chronic obstruction from a calculus,
stricture, or a tumor.
Middle aged females are more common to be affected.
A history of recurrent or chronic UTI usually present.
Produces either diffuse (80-90%), or sometimes focal
(10-20%), destruction of the kidney
Almost always unilateral; may affect either kidney with
equal frequency.
 Pathology
Pathognomonic microscopic feature is lipid-laden,
foamy macrophage (xanthoma cells).
The gross appearance of XGP is a mass of
yellow tissue with regional necrosis and
hemorrhage, superficially resembling
renal cell carcinoma.
Has tumor-like behavior and can spread to involve
and/or destroy adjacent organs.
 Clinical Picture
Fever.
Flank pain.
Weight loss.
Dysuria.
Flank mass & tenderness.
 Laboratory Investigations

CBC may reveal leukocytosis and anemia .

Urine analysis shows pyuria, hematuria, and
proteinuria.
E-Coli, Proteus species commonly appear in C/
S of urine of such cases.
 Radiology
The radiological modality of choice is CT, and it
shows:
Heterogeneous, non-enhancing mass
Hydronephrotic kidney
Destruction of the normal renal parenchyma
Stones, of staghorn size, occur in 80% of cases
May also demonstrate small calcifications
Extrarenal extension.
 Radiology
On ultrasound
Enlarged kidney which maintains reniform shape
Loss of corticomedullary differentiation
Multiple hypoechoic abscesses, granulomas or
dilated calyces
Loss of renal cortical tissue
 Radiology
Other radiological modalities:
* Plain X-ray.
* IVU.
* MRI.
* MAG-3, or Tc-DMSA renal scanning.
 Differential Diagnosis

Renal cell carcinoma

Chronic pyelonephritis.
 Treatment
Surgical removal
> Nephrectomy or sometimes partial nephrectomy.

Antibiotic therapy
> First-generation cephalosporins and trimethoprim-
sulfamethoxazole. A broader spectrum antibiotic maybe
needed in some cases.
 Prognosis

The overall prognosis for is good.

Death is rare.