RESUMEN
INTRODUCTION: Xanthogranulomatous pyelonephritis (XGPN) is a rare form of chronic renal inflammation, caused by long-term obstruction of the urinary tract. Pyonephrosis is a severe suppurative complication of acute obstructive pyelonephritis. Although minimally invasive approaches have many advantages, the safe dissection of the kidney may not be always achievable. MATERIALS AND METHODS: We reviewed 27 cases diagnosed with either XGPN or pyonephrosis, who underwent laparoscopic total nephrectomy between October 2016 and March 2022 in our department. All interventions were performed using the Karl Storz 3D laparoscopic system. The surgical approach was standard transperitoneal nephrectomy for the majority of XGPN, while pyonephrosis cases were carried out in a retroperitoneally. All procedures were performed or supervised by the same surgeon. RESULTS: The mean operative time was 269.85â¯minutes (range 145-360). The mean hemoglobin drop after surgery was 1.41â¯g/dl (range 0.3-2.3â¯g/dl). Difficult dissection was encountered in 13 cases (48.14%). Nine out of 13 interventions were carried out in a complete intracorporeal fashion, while conversion to open surgery was needed in 4 cases. Vascular complications involving the major blood vessels comprised of one case of inferior vena cava (IVC) tear. Digestive tract-related complications comprised two fistulas of the descending colon and one peritoneal breach. Multiorgan resection was performed in 6 cases. CONCLUSION: Total nephrectomy in cases of XGPN and pyonephrosis is a challenging procedure. The laparoscopic approach is feasible, as most complications are resolved intracorporeally. However, it may remain reserved for large-volume centers with experienced surgeons.
Asunto(s)
Laparoscopía , Nefrectomía , Pielonefritis Xantogranulomatosa , Pionefrosis , Humanos , Pielonefritis Xantogranulomatosa/cirugía , Pielonefritis Xantogranulomatosa/complicaciones , Laparoscopía/métodos , Pionefrosis/cirugía , Femenino , Persona de Mediana Edad , Nefrectomía/métodos , Masculino , Adulto , Estudios Retrospectivos , AncianoRESUMEN
BACKGROUND: In the emergency department (ED), pyelonephritis is a fairly common diagnosis, especially in patients with unilateral flank pain. Xanthogranulomatous pyelonephritis (XGP) is a rare type of pyelonephritis that is associated with unique features, which may lead to its diagnosis. CASE REPORT: A 30-year-old male patient presented to the ED for evaluation of right-sided abdominal pain that has been ongoing for the past 24 hours. He noted the pain was located predominantly in the right flank and described it as sharp in nature. The pain was nonradiating and was associated with scant hematuria. He stated that he had similar pains approximately 1 month earlier that resolved after a few days. The patient underwent a bedside ultrasound and a subsequent computed tomography (CT) scan of the abdomen and pelvis, which showed an enlarged, multiloculated right kidney with dilated calyces and a large staghorn calculus, findings that represent XGP. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report highlights an unusual variant of pyelonephritis, a relatively common ED diagnosis. XGP should be considered in patients with recurrent pyelonephritis, as treatment for XGP may require surgical intervention in addition to traditional antibiotic management.
Asunto(s)
Pielonefritis Xantogranulomatosa , Pielonefritis , Masculino , Humanos , Adulto , Pielonefritis Xantogranulomatosa/complicaciones , Pielonefritis Xantogranulomatosa/diagnóstico , Riñón , Pielonefritis/complicaciones , Pielonefritis/diagnóstico , Tomografía Computarizada por Rayos X , Dolor en el Flanco/etiologíaRESUMEN
The combination of systemic amyloid A (AA) amyloidosis and xanthogranulomatous pyelonephritis (XGP) resulting from a chronic urinary tract infection is extremely rare. We herein report a case of systemic AA amyloidosis secondary to XGP for which clinical remission developed after nephrectomy. To our knowledge, this is the first case report describing the clinical improvement of systemic AA amyloidosis secondary to XGP after nephrectomy in Japan. Clinicians should be aware of this uncommon combination and search for amyloid depositions in cases of XGP.
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Amiloidosis , Pielonefritis Xantogranulomatosa , Infecciones Urinarias , Humanos , Pielonefritis Xantogranulomatosa/complicaciones , Pielonefritis Xantogranulomatosa/diagnóstico por imagen , Pielonefritis Xantogranulomatosa/cirugía , Amiloidosis/complicaciones , Amiloidosis/diagnóstico , Nefrectomía/efectos adversos , Infecciones Urinarias/complicaciones , Proteína Amiloide A SéricaRESUMEN
BACKGROUND: Xanthogranulomatous pyelonephritis (XGP) is a rare chronic inflammatory condition of the kidney, associated with high patient morbidity, often requiring targeted antibiotic therapy and surgical removal of the affected kidney. AIM: We report the outcomes of patients undergoing nephrectomy for XGP in our institution over a 12-year period. METHODS: Following ethical approval, a retrospective review of histological samples of renal tissue demonstrating features of XGP from June 2010 to 2022 was conducted. Laboratory, imaging, and clinical data of included participants were collected. RESULTS: Eleven patients were included (8 women, 3 men), mean age of 58.1 (35-81). Recurrent urinary tract infection was the most common clinical presentation (55%, n = 6). Other presentations included flank pain (36%, n = 4), collection/ abscess (45%, n = 5), and nephro-cutaneous fistulae (9%, n = 1). The majority of patients had bacteriuria (91%, n = 10), and Escherichia coli was the most common bacteria isolated (55%, n = 6). Antibiotic resistance was seen in 60% of positive urine samples (n = 6). An open nephrectomy was performed in all but one case (91%, n = 10). A postoperative complication occurred in 73% (n = 8), with 50% (n = 4) of complications Clavien Dindo grade 3 or higher, including one patient mortality. CONCLUSIONS: XGP is a difficult and complex condition to treat. All patients in this series presented with infection or associated sequelae thereof. Complex XGP cases therefore often require open nephrectomy and have high rates of postoperative complications. Careful consideration of antibiotic and operative intervention is therefore essential to ensure the best outcome for these patients.
Asunto(s)
Pielonefritis Xantogranulomatosa , Infecciones Urinarias , Masculino , Humanos , Femenino , Persona de Mediana Edad , Pielonefritis Xantogranulomatosa/cirugía , Pielonefritis Xantogranulomatosa/complicaciones , Diagnóstico por Imagen , Estudios Retrospectivos , Nefrectomía/métodos , Infecciones Urinarias/tratamiento farmacológico , Complicaciones Posoperatorias , Antibacterianos/uso terapéuticoRESUMEN
RATIONALE: Xanthogranulomatous pyelonephritis (XGPN) is a form of chronic pyelonephritis caused by chronic calculus obstruction and bacterial infection, leading to the destruction of the renal parenchyma and calyces. Conservative treatment is usually not sufficient, and surgical intervention is still the main curative approach. XGPN with transdiaphragmatic extension and lung abscess formation is a rare condition. PATIENT CONCERNS: We report a 64-year-old woman who presented with persistent productive cough. DIAGNOSES: Lung abscess secondary to XPGN. Both nephrostomy urine and sputum cultures showed Proteus mirabilis infection with the same antibiotic sensitivity spectrum, but blood culture was negative. INTERVENTIONS: Laparoscopic radical nephrectomy and prolonged antibiotic treatment. OUTCOMES: The lung abscess and cough gradually resolved in 1 month after nephrectomy. CONCLUSION: Lung abscess secondary to transdiaphragmatic extension of XGPN is rare but should be considered in patients with lower lung infections that are unresponsive to treatment, especially infections due to unusual respiratory pathogens such as P mirabilis.
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Absceso Pulmonar , Pielonefritis Xantogranulomatosa , Femenino , Humanos , Persona de Mediana Edad , Pielonefritis Xantogranulomatosa/complicaciones , Pielonefritis Xantogranulomatosa/diagnóstico , Pielonefritis Xantogranulomatosa/cirugía , Absceso Pulmonar/complicaciones , Tos/complicaciones , Riñón/cirugía , Nefrectomía , Enfermedad Crónica , Antibacterianos/uso terapéuticoRESUMEN
INTRODUCTION: Xanthogranulomatous pyelonephritis is an inflammatory disease characterized by chronic obstruction and infection. This pathology is a life-threatening condition when surgical treatment is carried out. We decided to retrospectively evaluate whether there were perioperative factors that predict complications in patients who undergo nephrectomy. METHODS: We reviewed all nephrectomies done in the period of 2013-2018, in a tertiary referral Hospital with the histopathological diagnosis of Xanthogranulomatous Pyelonephritis. RESULTS: The presence of renal abscess at admission was observed as a risk factor associated with perioperative complications (p = 0.002), presence of abscess was observed in 47.4% of subjects without complications compared to 89.3% of the perioperative complication group. Higher rates of blood transfusion requirement were observed in the perioperative complication group, 89.3% compared to 68.4% (p = 0.029), furthermore, perioperative bleeding was slightly greater in the complication group compared to its counterpart, 700 mL, and 600 mL, respectively (p = 0.01). CONCLUSIONS: Anemia and the presence of abscess were important perioperative factors that predict perioperative complications.
Asunto(s)
Pielonefritis Xantogranulomatosa , Infecciones Urinarias , Humanos , Pielonefritis Xantogranulomatosa/complicaciones , Pielonefritis Xantogranulomatosa/diagnóstico , Pielonefritis Xantogranulomatosa/cirugía , Absceso/complicaciones , Estudios Retrospectivos , Nefrectomía , Infecciones Urinarias/cirugíaRESUMEN
PURPOSE: Xanthogranulomatous pyelonephritis (XGP) is a rare form of pyelonephritis more commonly seen in females and diabetics. Frequently associated with renal tract calculi, it is often difficult to diagnose, as it can clinically and radiologically mimic other disorders. Most cases are treated with antibiotics and nephrectomy. The aim of our review is to summarise and analyse the current evidence focusing on management. METHODS: A literature search was conducted to identify papers relating to xanthogranulomatous pyelonephritis in adults. Studies containing ten or more patients with XGP were included for descriptive analysis, and a meta-analyses of cohort studies conducted comparing open and minimally invasive nephrectomy undertaken. Other papers were included for narrative review. RESULTS: 52 studies were identified, 20 were included for narrative review and 32 retrospective observational studies containing 868 patients were included for descriptive analysis. 99.8% of patients underwent nephrectomy, about one-third laparoscopically. The most commonly cultured organisms were Escherichia coli and Proteus mirabilis. 60% of patients, where reported, underwent preoperative drainage. Seven studies containing 211 patients were included for meta-analysis which found that postoperative complications, length of stay and transfusion requirements were all significantly reduced in those who underwent minimally invasive surgery. CONCLUSION: The mainstay management of XGP is antibiotic therapy and nephrectomy. Some studies highlight a role for preoperative upper urinary tract drainage, but evidence supporting this is limited. We present the first meta-analyses examining operative approach for patients undergoing nephrectomy for XGP. Though limited by the data available, our meta-analysis indicates minimally invasive nephrectomy for XGP provides better postoperative outcomes.
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Pielonefritis Xantogranulomatosa , Adulto , Antibacterianos/uso terapéutico , Estudios de Cohortes , Drenaje , Femenino , Humanos , Nefrectomía , Pielonefritis Xantogranulomatosa/complicaciones , Pielonefritis Xantogranulomatosa/diagnóstico , Pielonefritis Xantogranulomatosa/cirugía , Estudios RetrospectivosRESUMEN
ABSTRACT: Xanthogranulomatous pyelonephritis is a rare disease that was often accompanied with urinary obstruction. The focal form of xanthogranulomatous pyelonephritis is frequently misdiagnosed as malignancy. Here we present FDG PET/CT findings of a case focal xanthogranulomatous pyelonephritis in a 66-year-old woman with polycystic liver and kidney disease. The image showed a polycystic mass in the inferior pole of right kidney with high FDG uptake in the cystic wall, which was suggestive of a cystic renal carcinoma. Right radical nephrectomy was subsequently performed. The postsurgical pathology revealed xanthogranulomatous pyelonephritis.
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Carcinoma de Células Renales , Neoplasias Renales , Pielonefritis Xantogranulomatosa , Anciano , Carcinoma de Células Renales/complicaciones , Diagnóstico Diferencial , Femenino , Fluorodesoxiglucosa F18 , Humanos , Neoplasias Renales/complicaciones , Neoplasias Renales/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Pielonefritis Xantogranulomatosa/complicaciones , Pielonefritis Xantogranulomatosa/diagnóstico por imagenAsunto(s)
Antibacterianos/uso terapéutico , Empiema Pleural/etiología , Pielonefritis Xantogranulomatosa/complicaciones , Anciano , Empiema Pleural/diagnóstico , Empiema Pleural/tratamiento farmacológico , Femenino , Humanos , Pielonefritis Xantogranulomatosa/diagnóstico , Tomografía Computarizada por Rayos XAsunto(s)
Cálculos/terapia , Drenaje , Nefrotomía , Absceso del Psoas/terapia , Pielonefritis Xantogranulomatosa/complicaciones , Cálculos/diagnóstico por imagen , Cálculos/etiología , Femenino , Humanos , Persona de Mediana Edad , Absceso del Psoas/diagnóstico por imagen , Absceso del Psoas/etiología , Pielonefritis Xantogranulomatosa/diagnóstico por imagen , Radiografía Intervencional , Resultado del TratamientoRESUMEN
BACKGROUND: Xanthogranulomatous pyelonephritis is characterized by the inflammatory destruction of the renal parenchyma and intensive renal fibrosis. It is named because of its pathological appearance; that of its granulomatous inflammatory process with lipid-laden macrophages, which appear yellow, hence `xantho` which is Greek for yellow. Xanthogranulomatous pyelonephritis is predominantly a disease of adults. In children it is diagnosed sporadically and is extremely rare in infants. The age of onset varies (21 days to 16 years), although 60-75% of cases have been diagnosed before 5 years of age. Recurrent urinary tract infections, obstructive nephropathy caused by renal calculus, malnutrition, abnormal lipid metabolism, altered immunologic response, lymphatic blockage, congenital urinary anomalies have been implicated in the etiology of xanthogranulomatous pyelonephritis in children. CASE: We report an unusual case of xanthogranulomatous pyelonephritis in a 5-year-old girl and discuss its clinical features, histopathological findings and treatment. In this article, we also emphasized the importance of diagnostic imaging in urinary tract infections which enabled us not to miss the underlying kidney stone disease. CONCLUSION: Nephrolithiasis may lead to very serious conditions such as xanthogranulomatous pyelonephritis. This condition can be easily diagnosed by ultrasound, but if not detected, it can lead to complete loss of renal function as in the case.
Asunto(s)
Cálculos , Pielonefritis Xantogranulomatosa , Adulto , Niño , Preescolar , Femenino , Humanos , Lactante , Riñón , Pielonefritis Xantogranulomatosa/complicaciones , Pielonefritis Xantogranulomatosa/diagnóstico , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
Xanthogranulomatous pyelonephritis is associated with obstruction, stones and infection. CT is the mainstay of diagnosis, but appearances can mimic other conditions, including renal cell carcinoma. Nephrectomy is commonly recommended, but conservative treatment with antibiotics has been described after tissue diagnosis. We present a case of xanthogranulomatous pyelonephritis with concomitant renal cell carcinoma, which was an association that was suggested in 1988 and supported by subsequently reported cases. Conservative management of biopsy or cytology proven xanthogranulomatous pyelonephritis is unsafe, as an area of synchronous malignant tumour may be missed: we recommend it only in patients unfit for nephrectomy.
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Carcinoma de Células Renales/diagnóstico , Neoplasias Renales/diagnóstico , Pielonefritis Xantogranulomatosa/diagnóstico , Anciano , Carcinoma de Células Renales/complicaciones , Carcinoma de Células Renales/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Fiebre/etiología , Humanos , Neoplasias Renales/complicaciones , Neoplasias Renales/diagnóstico por imagen , Nefrectomía , Pielonefritis Xantogranulomatosa/complicaciones , Pielonefritis Xantogranulomatosa/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Entero-urinary fistulas are uncommon in urological practice and may have widely varying aetiologies ranging from benign to malignant or iatrogenic in nature. All permutations of entero-urinary fistulas have been reported in the literature except an appendico-renal fistula. Here, we present one such case, presenting with urinary tract infections and perineal urethrocutaneous fistulae. He was ultimately diagnosed to have a spontaneous appendico-renal fistula as underlying pathology behind the symptoms.
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Fístula Intestinal/etiología , Cálculos Renales/diagnóstico por imagen , Pielonefritis Xantogranulomatosa/diagnóstico por imagen , Fístula de la Vejiga Urinaria/etiología , Humanos , Fístula Intestinal/diagnóstico por imagen , Cálculos Renales/cirugía , Masculino , Nefrectomía , Pielonefritis Xantogranulomatosa/complicaciones , Pielonefritis Xantogranulomatosa/cirugía , Procedimientos de Cirugía Plástica , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Ultrasonografía , Fístula de la Vejiga Urinaria/diagnóstico por imagen , Adulto JovenRESUMEN
Xanthogranulomatous inflammation, characterized by destruction and replacement of tissues with chronic inflammatory cells, including foamy histiocytes and hemosiderin-laden macrophages, is uncommon. In patients with xanthogranulomatous pyelonephritis, inflammation may extend from the kidney to the overlying duodenum, creating a pyeloduodenal fistula that further complicates medical and surgical management. We present two cases with recurrent kidney infections who each ultimately received a nephrectomy and repair of their duodenal fistula.