Indian Journal of Urology
CASE REPORT
Year
: 2000  |  Volume : 16  |  Issue : 2  |  Page : 153--154

Xanthogranulomatous pyelonephritis in children


Anita Sharma, Kamal Nain Rattan, BB Arora, Sanjiv Nanda 
 Departments of Pediatric Medicine, Pediatric Surgery and Pathology, Pt. B.D.S. Medical College & Hospital, Rohtak, India

Correspondence Address:
Anita Sharma
39/9J Medical Enclave, Rohtak - 124 001
India




How to cite this article:
Sharma A, Rattan KN, Arora B B, Nanda S. Xanthogranulomatous pyelonephritis in children.Indian J Urol 2000;16:153-154


How to cite this URL:
Sharma A, Rattan KN, Arora B B, Nanda S. Xanthogranulomatous pyelonephritis in children. Indian J Urol [serial online] 2000 [cited 2020 Sep 23 ];16:153-154
Available from: http://www.indianjurol.com/text.asp?2000/16/2/153/22217


Full Text

 Case Summary



Two children (Case I: 1-year-old boy and Case II: 9­year-old girl) presented with history of fever, difficulty in micturation and mass in abdomen in right lumbar area for a duration of 9 months and one year respectively. On in­vestigation, both had hydronephrosis with pyonephrosis of right kidney on ultrasowA which was non functional on intravenous pyelography. In case I, on ultrasound guided nephrostomy, 50 cc thin pus was aspirated out which was sterile on culture. Case II in addition had a radio-opaque stone in pelvis of right kidney. With a clinical diagnosis of chronic pyelonephritis with pyonephrosis and pelvic ureteric obstruction, right radical nephroureterectomy was undertaken. On gross examination, kidney was enlarged, external surface was congested and nodular and renal cap­sule was thickened. On cut section cortex was friable, had multiple yellowish patches and could not be differenti­ated from medulla. Entire renal parenchyma was replaced by yellowish raised areas with exudates, pelvicalcyceal system was dilated and full of thick pus. Histologically there was diffuse granulomatous inflammatory infiltrate which included large number of foamy histiocytes, an occasional multinucleated giant cell along with lymphocytes, plasma cells and neutrophils. No renal pa­renchyma was identifiable in most of the affected areas [Figure 1]. Urine and renal pus were sterile. The children have been followed up for one year without any recurrence of symptoms.

 Discussion



Xanthogranulomatous pyelonephritis is an atypical form of chronic pyelonephritis characterized by diffuse, focal or segmental suppurative destruction of renal parenchyma and presence of granulomata, abscesses and masses of li­pid laden foam cells. [1] It is usually seen in middle-aged women, but is not as rare in children as it was earlier thought to be. [1],[2]

A preoperative diagnosis of xanthogranulomatous pye­lonephritis is usually difficult because its clinical and ra­diological features mimic those of renal neoplastic and inflammatory diseases. As reported in literature, both our patients also had the commonly reported symptoms of lumbar pain, palpable mass and history of recurrent fever and urinary tract infection. Discharging flank sinus, hematuria and hypertension either at initial presentation or at fol­low-up are uncommonly reported features. [1],[2],[3]

Diffuse type of xanthogranulomatous pyelonephritis involving both the kidneys has ben uncommonly observed in children. In this report both patients had diffuse type of xanthogranulomatous pyelonephritis involving only right kidney. Both had typical histology, but occasionally it may be difficult to differentiate it from renal tuberculo­sis, malakoplakia and renal cell carcinoma. [1],[2],[3]

References

1Kawaichi GN. Reingold IM. Xanthogranulomatous pyelonephritis in the paraplegic. J Urol 1967; 97:58-61.
2D'Costa GF, Nagle SB, Wagholikar UL, Nathani RR. Xantho­granulomatous pyelonephritis in children and adults - an 8 year study. Indian J Urol Microbiol 1990; 33:224-229.
3Cohen MS. Granulomatous nephritis. Urol Clin North Am 1986;13:647-659.