ABSTRACT
Objective To discuss the clinical diagnosis and treatment of xanthogranulomatous pyelonephritis (XGP).Methods Clinical data of 41 XGP patients admitted from May 1981 to December 2017 were retrospectively analyzed.There were 17 male cases and 24 female cases,aged from 23 to 78 years,with an average age of 57 years.All were unilateral lesions,including 19 cases on the left and 22 cases on the right.Disease duration ranged from 1 week to 12 years,with an average of 3.5 years.The clinical manifestations showed that 7 cases with gross hematuria (17.1％),16 cases with palpable flank or abdominal mass (39.0％),36 cases with flank pain (87.8％),26 cases with acute or intermittent fever (63.4％) and 17 cases with weight loss (41.5％).Laboratory findings showed that 28 cases with leukocytosis (68.3％),24 cases with anemia (58.5％),27 cases with pyuria (65.9％),positive urine culture 19/34 (55.9％),positive urine lipid-laden macrophages 3/14(21.4％),and 20 cases with rapid erythrocyte sedimentation rate (48.8％).Imaging examination:among 35 patients who received CT examination,25 were diagnosed as XGP,mainly presenting diffuse changes in the kidney with enlarged renal shadow,accompanied by diffusive distribution of multiple low-density lesions.There was no obvious enhancement in the low-density lesions on enhanced scan,accompanied by thickening of renal fascia,adhesion to psoas major muscle or involvement of surrounding tissues and organs.According to the imaging results,there were 33 cases of diffuse type and 8 cases of localized type in this group.Renal biopsy was performed 11 cases and 3 cases were diagnosed as XGP.Results All patients were treated with surgical procedure.33 patients with diffuse type were performed nephrectomy.6 of the 8 patients with localized type underwent partial nephrectomy successfully,and the other 2 patients underwent nephrectomy due to severe renal adhesion and unclear lesion boundaries.All postoperative pathologies suggested xanthogranulomatous pyelonephritis.Patients were followed up for 9 months to 10 years postoperatively,with an average of 4.5 years.All patients had no recurrence.Conclusions The clinical manifestations of XGP are lack of specificity.Diagnosis is difficult and depends on pathology.According to imaging examination,lesions can be divided into diffuse type and localized type.Nephrectomy and partial nephrectomy were performed respectively.