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Xanthogranulomatous pyelonephritis: critical analysis of 30 patients

  • Urology – Original Paper
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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.

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Acknowledgments

This study was supported by grants from the Ta-Tung Kidney Foundation and the Mrs Hsiu-Chin Lee Kidney Research Fund, Taipei, Taiwan.

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Authors and Affiliations

  1. Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan

    Chin-Chi Kuo & Ching-Wei Tsai

  2. Department of Internal Medicine, National Taiwan University Hospital, #7 Chung-Shan South Road, Taipei, Taiwan

    Ching-Fang Wu, Vin-Cent Wu, Yung-Ming Chen, Ming-Shiou Wu, Tzong-Shinn Chu & Kwan-Dun Wu

  3. Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan

    Wei-Chou Lin

  4. Department of Urology, National Taiwan University Hospital, Taipei, Taiwan

    Yuan-Ju Lee

  5. Department of Medical Imaging, Far Eastern Memorial Hospital, Taipei, Taiwan

    Chun-Chieh Huang

Authors
  1. Chin-Chi Kuo
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Correspondence to Ming-Shiou Wu.

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The authors Chin-Chi Kuo and Ching-Fang Wu equally contributed.

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Kuo, CC., Wu, CF., Huang, CC. et al. Xanthogranulomatous pyelonephritis: critical analysis of 30 patients. Int Urol Nephrol 43, 15–22 (2011). https://doi.org/10.1007/s11255-010-9778-8

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  • DOI: https://doi.org/10.1007/s11255-010-9778-8

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