Pramod Jagadeesh Makannavar1, Srinivas Kalabavi2, Revanasiddappa Kanagali3, Bhuvanesh Aradhya4, Sangamnath5
BACKGROUND
Xanthogranulomatous pyelonephritis (XGP) is an uncommon form of chronic
pyelonephritis that is characterized by extensive enlargement and destruction of
the involved kidney which ultimately results in non-functioning kidney. It often
mimics other inflammatory or neoplastic renal disorders. Unlike chronic
pyelonephritis, it spreads to the perinephric space with formation of multiple
abscesses and fistulas. It is now being recognized as an important cause of renal
morbidity and mortality worldwide.
METHODS
This is a case series undertaken in a tertiary care center. Clinical data was collected
from last 6 years. Clinical features, radiological findings, treatment, and its
outcome were analysed and presented.
RESULTS
A total of 23 cases diagnosed clinically were included in our study. The disease is
more prevalent in females than in males with ratio of 1.8 : 1, with mean age of
47.04 years. Most of the patients presented with flank pain and fever. 2 patients
had unusual presentations that are nephrocutaneous fistula and necrotising
fasciitis of flank region. In our study, disease was associated with urolithiasis in
43.47 % and diabetes mellitus (DM) in 60.8 %. E. coli was the most commonly
grown organism in urine culture. Most of the patients underwent initial
percutaneous nephrostomy (PCN) or double-J (DJ) stenting followed by definitive
treatment that is nephrectomy (21 patients, 2 patients lost to follow up).
Extraperitoneal flank approach was most commonly chosen compared to subcostal
transperitoneal approach. Excess blood loss was the most common complication
encountered during surgery; 8 patients required post-operative blood transfusion.
5 patients required intensive care unit (ICU) care with inotropic support postoperatively.
6 patients had post-operative superficial surgical site infection.
CONCLUSIONS
XGP is a rare form of chronic pyelonephritis resulting in enlarged non-functioning
kidney. UTI (urinary tract infection) and urolithiasis are the most important factors
involved in pathogenesis. Prompt diagnosis and treatment is essential. Initial
antibiotic treatment with drainage procedure (PCN or DJ stenting) followed by
nephrectomy is treatment of choice. Early diagnosis and treatment may limit the
disease process and associated morbidity, thus leading to good outcome.
