Abstract

LEONI, Alberto Francisco et al. Xanthogranulomatous pyelonephritis: Review of 10 cases. Arch. Esp. Urol. [online]. 2009, vol.62, n.4, pp.259-271. ISSN 0004-0614.

Objective: To report our experience with clinical presentation, appearance, diagnosis and treatment of Xanthogranulomaous pyelonephritis (XP). Methods: Multicenter, observational, descriptive and retrosprospective study carried out during six years. Results: We studied 10 patients, 8 women and 2 males, with an average age of 50 years. All cases presented with lumbar and abdominal pain, loss of weight, conjuntival pallor, renal lithiasis and chronic evolution. Fever and palpable abdominal mass, were present in 80% of cases and 60% presented history of urinary tract infection. Initial diagnosis, in most cases, was pyonephrosis. Two cases (20 %) were associated with cancer and other 2 (20%) with Psoriasis. Mortality was of 10%. Laboratory hallmark were anemia, high SGV rate and leukocytosis. Urinary sediment showed pyuria. Urine culture was positive in the 50% of the patients. On the other hand urine cultures obtained from nephrostomy tube were always positive. The onset was unilateral and diffuse in all cases without predominance in the location. Direct abdominal x-ray showed lithiasis, ultrasound showed increased renal size, with a pattern of hydronephrosis and/or intrapa-renchymatous abscesses. CT scan was useful to demonstrate disease extension. Conclusions: Xanthogranulomatous pyelonephritis (XP) is a chronic and unusual inflammatory-infectious disease with acute episodes involving renal parenchyma. Most cases appear in medium aged women. Histopa-thologic study offers the accurate diagnosis. Antibiotic therapy avoids septic complications. Total or partial nephrectomy is the definitive treatment. We propose nephrostomy because it facilitates the microbiological diagnosis and surgery (nephrectomy).

Keywords : Xanthogranulomatous pyelonephritis; Clinical presentation; Diagnosis; Treatment; Nephrostomy.

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