International Urology and Nephrology

, Volume 43, Issue 1, pp 15–22

Xanthogranulomatous pyelonephritis: critical analysis of 30 patients

  • Chin-Chi Kuo
  • Ching-Fang Wu
  • Chun-Chieh Huang
  • Yuan-Ju Lee
  • Wei-Chou Lin
  • Ching-Wei Tsai
  • Vin-Cent Wu
  • Yung-Ming Chen
  • Ming-Shiou Wu
  • Tzong-Shinn Chu
  • Kwan-Dun Wu
Urology – Original Paper

Abstract

Introduction and objective

Xanthogranulomatous pyelonephritis (XGP) is a chronic inflammatory condition of the kidneys. Nevertheless, disparities between the pre-operative and pathological diagnoses are frequently encountered. We reviewed all patients with XGP over a 17-year period to identify and characterize the pre-operative and pathological characteristics of the disease in our patients.

Methods

A comprehensive review of all nephrectomy patients with a pre-operative diagnosis of pyelonephritis at National Taiwan University Hospital from 1991 to 2008 with the pathological diagnosis of XGP was conducted to demonstrate the clinical and radiological characteristics of XGP.

Results

XGP was diagnosed in 30 (18.6%) of the 160 nephrectomies performed for pyelonephritis. Of the 30 patients with XGP, 25 were women (83.3%) and 20 (66.7%) were overweight (body mass index >23). Their mean age was 55.17 years. The average serum creatinine level was 1.68 mg/dL. The image findings included renal calculi (56.7%), staghorn stones (26.7%), and spread of the disease to the retroperitoneum and psoas muscle (33.3%). Escherichia coli (36.7%) was the most prevalent pathogen. The mortality of the two-stage surgical treatment was zero, and morbidity developed in only 1 patient (4.8%).

Conclusion

The key to accurate pre-operative diagnosis is to keep risk factors in mind such as age, sex, and renal calculi. Clinicians should maintain a high suspicion of XGP for early recognition and be aware of the care of chronic kidney disease. Finally, the association between XGP and central obesity warrants further research.

Keywords

Xanthogranulomatous pyelonephritis Body mass index Visceral adipose tissue Chronic kidney disease 

References

  1. 1.
    Schlagenhaufer F (1916) Uber eigentumlich staphylomykosen der neiven und des pararenalen bindegewebes. Frankfurt Z Pathol 19:139–148Google Scholar
  2. 2.
    Ballesteros Sampol JJ (1989) Up-date on renal xanthogranulomatosis: (comparison of personal experience in 66 cases and the 720 cases from the literature). Actas Urol Esp 13:10–18PubMedGoogle Scholar
  3. 3.
    Malek RS, Elder JS (1978) Xanthogranulomatous pyelonephritis: a critical analysis of 26 cases and of the literature. J Urol 119:589–593PubMedGoogle Scholar
  4. 4.
    Rosi P, Selli C, Carini M, Rosi MF, Mottola A (1986) Xanthogranulomatous pyelonephritis: clinical experience with 62 cases. Eur Urol 12:96–100PubMedGoogle Scholar
  5. 5.
    Proca E, Lucan M, Alexianu M (1988) Xanthogranulomatous pyelonephritis. Comments apropos 145 clinical cases. Rev Chir Oncol Radiol ORL Oftalmol Stomatol Chir 37:451–466Google Scholar
  6. 6.
    Mhiri MN, Sellami F, Njeh M, Rebai T, Smida ML (1991) Xanthogranulomatous pyelonephritis. Apropos of 42 cases. Ann Urol 25:113–117Google Scholar
  7. 7.
    Chuang CK, Lai MK, Chang PL et al (1992) Xanthogranulomatous pyelonephritis: experience in 36 cases. J Urol 147:333–336PubMedGoogle Scholar
  8. 8.
    Fernandez Rodriguez A, Camarasa Garcia F, Guerra Prieto MF, Macian Cervera MJ, Beltran Beltran S, Puras Tellaeche A (1997) Xanthogranulomatous pyelonephritis: experience at the General Hospital of Albacete. Report of 16 cases. An Med Interna 14:62–66PubMedGoogle Scholar
  9. 9.
    Zorzos I, Moutzouris V, Korakianitis G, Katsou G (2003) Analysis of 39 cases of xanthogranulomatous pyelonephritis with emphasis on CT findings. Scand J Urol Nephrol 37:342–347PubMedCrossRefGoogle Scholar
  10. 10.
    Korkes F, Favoretto RL, Broglio M, Silva CA, Castro MG, Perez MD (2008) Xanthogranulomatous pyelonephritis: clinical experience with 41 cases. Urology 71:178–180PubMedCrossRefGoogle Scholar
  11. 11.
    Masoom S, Venkataraman G, Jensen J, Flanigan RC, Wojcik EM (2009) Renal FNA-based typing of renal masses remains a useful adjunctive modality: evaluation of 31 renal masses with correlative histology. Cytopathology 20(1):50–55PubMedCrossRefGoogle Scholar
  12. 12.
    Raziel A, Steinberg R, Kornreich L et al (1997) Xanthogranulomatous pyelonephritis mimicking malignant disease: is preservation of the kidney possible? Pediatr Surg Int 12:535–537PubMedCrossRefGoogle Scholar
  13. 13.
    Perez LM, Netto JM, Induhara R, Mroczek-Musulman E (1999) Xanthogranulomatous pyelonephritis in an infant with an obstructed upper pole renal moiety. Urology 54:744PubMedCrossRefGoogle Scholar
  14. 14.
    Rassweiler J, Fornara P, Weber M et al (1998) Laparoscopic nephrectomy: the experience of the laparoscopy working group of the German Urologic Association. J Urol 160:18–21PubMedCrossRefGoogle Scholar
  15. 15.
    Tobias-Machado M, Lasmar MT, Batista LT, Forseto PH Jr, Juliano RV, Wroclawski ER (2005) Laparoscopic nephrectomy in inflammatory renal disease: proposal for a staged approach. Int Braz J Urol 31:22–28PubMedGoogle Scholar
  16. 16.
    Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41PubMedCrossRefGoogle Scholar
  17. 17.
    Levey AS, Coresh J, Balk E et al (2003) National kidney foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 139:137–147PubMedGoogle Scholar
  18. 18.
    Ko GT, Tang J, Chan JC et al (2001) Lower BMI cut-off value to define obesity in Hong Kong Chinese: an analysis based on body fat assessment by bioelectrical impedance. Br J Nutr 85:239–242PubMedCrossRefGoogle Scholar
  19. 19.
    Saavedra Jo S, Pow-Sang Godoy M, Benavente Corrales V et al (2004) Xanthogranulomatous pyelonephritis: clinical, radiological and pathologic characteristics. Arch Esp Urol 57:595–600PubMedGoogle Scholar
  20. 20.
    Al-Ghazo MA, Ghalayini IF, Matalka II, Al-Kaisi NS, Khader YS (2006) Xanthogranulomatous pyelonephritis: analysis of 18 cases. Asian J Surg 29:257–261PubMedCrossRefGoogle Scholar
  21. 21.
    Loffroy R, Guiu B, Watfa J, Michel F, Cercueil JP, Krause D (2007) Xanthogranulomatous pyelonephritis in adults: clinical and radiological findings in diffuse and focal forms. Clin Radiol 62:884–890PubMedCrossRefGoogle Scholar
  22. 22.
    Matthews GJ, McLorie GA, Churchill BA, Steckler RE, Khoury AE (1995) Xanthogranulomatous pyelonephritis in pediatric patients. J Urol 153:1958–1959PubMedCrossRefGoogle Scholar
  23. 23.
    Tsai C-W, Chan D-C, Kuo C-C, Lee Y-J, Huang C-C (2009) Kidney packed with fat, pus and stone-xanthogranulomatous pyelonephritis. NDT plus 2:257–258CrossRefGoogle Scholar
  24. 24.
    Dwivedi US, Goyal NK, Saxena V et al (2006) Xanthogranulomatous pyelonephritis: our experience with review of published reports. ANZ J Surg 76:1007–1009PubMedCrossRefGoogle Scholar
  25. 25.
    Guzzo TJ, Bivalacqua TJ, Pierorazio PM, Varkarakis J, Schaeffer EM, Allaf ME (2009) Xanthogranulomatous pyelonephritis: presentation and management in the era of laparoscopy. BJU Int 104:1265–1268PubMedCrossRefGoogle Scholar
  26. 26.
    Leoni FA, Kinleiner P, Revol M, Zaya A, Odicio A (2009) Xanthogranulomatous pyelonephritis: review of 10 cases. Arch Esp Urol 62:259–271PubMedCrossRefGoogle Scholar
  27. 27.
    Reese PP, Feldman HI, Asch DA, Thomasson A, Shults J, Bloom RD (2009) Short-term outcomes for obese live kidney donors and their recipients. Transplantation 88:662–671PubMedCrossRefGoogle Scholar
  28. 28.
    Kim JC (2001) US and CT findings of xanthogranulomatous pyelonephritis. Clin Imaging 25:118–121PubMedCrossRefGoogle Scholar
  29. 29.
    Tiu CM, Chou YH, Chiou HJ et al (2001) Sonographic features of xanthogranulomatous pyelonephritis. J Clin Ultrasound 29:279–285PubMedCrossRefGoogle Scholar
  30. 30.
    Kim J (2004) Ultrasonographic features of focal xanthogranulomatous pyelonephritis. J Ultrasound Med 23:409–416PubMedGoogle Scholar
  31. 31.
    Fallatah A, Tarakji M, Amuesi J (2001) Xanthogranulomatous pyelonephritis: a retrospective study of 10 cases and review of the literature. Saudi J Kidney Dis Transpl 12:520–524PubMedGoogle Scholar
  32. 32.
    Lumeng CN, Bodzin JL, Saltiel AR (2007) Obesity induces a phenotypic switch in adipose tissue macrophage polarization. J Clin Invest 117:175–184PubMedCrossRefGoogle Scholar
  33. 33.
    Swirski FK, Libby P, Aikawa E et al (2007) Ly-6Chi monocytes dominate hypercholesterolemia-associated monocytosis and give rise to macrophages in atheromata. J Clin Invest 117:195–205PubMedCrossRefGoogle Scholar
  34. 34.
    Tacke F, Alvarez D, Kaplan TJ et al (2007) Monocyte subsets differentially employ CCR2, CCR5, and CX3CR1 to accumulate within atherosclerotic plaques. J Clin Invest 117:185–194PubMedCrossRefGoogle Scholar
  35. 35.
    Gordon S (2007) Macrophage heterogeneity and tissue lipids. J Clin Invest 117:89–93PubMedCrossRefGoogle Scholar
  36. 36.
    Gordon S, Taylor PR (2005) Monocyte and macrophage heterogeneity. Nat Rev Immunol 5:953–964PubMedCrossRefGoogle Scholar
  37. 37.
    Lear SA, Humphries KH, Kohli S, Chockalingam A, Frohlich JJ, Birmingham CL (2007) Visceral adipose tissue accumulation differs according to ethnic background: results of the Multicultural Community Health Assessment Trial (M-CHAT). Am J Clin Nutr 86:353–359PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2010

Authors and Affiliations

  • Chin-Chi Kuo
    • 1
  • Ching-Fang Wu
    • 2
  • Chun-Chieh Huang
    • 5
  • Yuan-Ju Lee
    • 4
  • Wei-Chou Lin
    • 3
  • Ching-Wei Tsai
    • 1
  • Vin-Cent Wu
    • 2
  • Yung-Ming Chen
    • 2
  • Ming-Shiou Wu
    • 2
  • Tzong-Shinn Chu
    • 2
  • Kwan-Dun Wu
    • 2
  1. 1.Department of Internal MedicineNational Taiwan University HospitalYun-LinTaiwan
  2. 2.Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
  3. 3.Department of PathologyNational Taiwan University HospitalTaipeiTaiwan
  4. 4.Department of UrologyNational Taiwan University HospitalTaipeiTaiwan
  5. 5.Department of Medical ImagingFar Eastern Memorial HospitalTaipeiTaiwan

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