Xanthogranulomatous Pyelonephritis

Short Communication


Muftah Mohamed Elgarba, Ahmed Sobhy Elhefnawi

Mansoura Urology, Nephrology Centre, Mansoura, Egypt

JMJ Vol.8, No.1 (Spring) 2008:65-67


Objectives: We conducted this study at Mansoura Urology and Nephrology Centre on thirty nine histopathologically proved XGP. Clinical, laboratory, radiological features and treatment modalities, histopathological correlation and possible risk factors are presented. Patients and methodology: We reviewed the computed charts of thirty nine patients with XGP seen at our centre, between January 1992 and July 2006. Demographic data of patients, laboratory and imaging studies, treatment modalities and perioperative complication were discussed. Results: There were 13% of cases below 18 years of age, and 87% more than 18 years. Flank pain was the major presenting complaint in 82%, and discharging sinus in 10%, the second. All patients had normal renal function tests, rheumatoid factor (RF) was positive in about 48.7%, urine culture sensitivity was positive for bacterial growth in 48.7%, nephrolithiasis were found in 84,6%, there was one case with focal XGP which was treated by partial nephrectomy and another case underwent pyelolithotomy with partial nephrectomy while the remaining 37 cases underwent total nephrectomy one of them via laproscopy. Perioperative complication included, pleural tear (3 patients), colonic injury (one patient), septicaemia (5 patients) and hepatic injury (one patient) . Conclusion: The aetiology of XGP remains a mystery although it is usually associated with urinary tract obstruction, infection and urolithiasis and this issue is supported in our series and we noticed that rheumatoid factor is positive in almost half (48,7%) of cases, which could be attributed as a risk factor. Perinephric discharging sinus was not uncommon (10% of our cases). Because of chronicity and massive fibrosis the perioperative complicatons were significant so diligent dissection was required. Attacks of pain, positive RF with or without nephrolithiasis and perinephric collection raise the suspicion of XGP and more conservative treatment modalities can be applied, since there have been reports of successful medical treatment of focal XGP.

Keywords: Xanthogranulomatous pyelonephritis (XGP), Nephrectomy, Laparoscopic

Link/DOI: http://www.jmj.org.ly/modules.php?name=News&file=article&sid=1455