A Rare Cause of Chronic Pyelonephritis: Xanthogranulomatous Pyelonephritis

Abstract

Xanthogranulomatous pyelonephritis (XGP) is a chronic, destructive, granulomatous inflammation of the renal parenchyma leading non-functioning kidney. Contrast-enhanced computed tomography is the most useful diagnostic method. A 6-year-old female patient admitted to us with complaints of abdominal pain, fever, fatigue, weakness. Recurrent urinary tract infection was present in her history. The patient’s urine specimen revealed leukocyturia, hematuria, positive for nitrite and bacteria, white blood cell: 12.7x103 /microl, hemoglobin:6.2 g/dl and CRP: 101 mg/dl. In the urinary system USG imaging, the contours of the left kidney were irregular and lobulated, and medullary punctate echogenicity and calcifications were present. Contrast-enhanced abdominal computed tomography showed increased left kidney size and opacities suggestive of stone in the collecting system; pararenal area was heterogeneous. Although the patient's gentamicin treatment was completed in 7 days and meropenem treatment in 14 days, acute phase reactants did not regress. No activity uptake was observed in the left kidney lodge in renal cortical scintigraphy. Left total nephrectomy was performed with the diagnosis of non-functioning left kidney and chronic pyelonephritis. Kidney biopsy material were reported as XGP. XGP is a rare and aggressive cause of chronic pyelonephritis with serious consequences such as nephrectomy requirement.

Keywords

• Chronic pyelonephritis
• Pyelonephritis
• Urinary tract infections
• Xanthogranulomatous pyelonephritis
• XGP

Kronik Piyelonefritin Nadir Bir Nedeni: Ksantogranulomatöz Piyelonefrit

Abstract

Ksantogranülomatöz piyelonefrit (XGP), böbrek parankiminin fonksiyon kaybına yol açan kronik, yıkıcı, granülomatöz bir enflamasyonudur. Kontrastlı bilgisayarlı tomografi en yararlı tanı yöntemidir. Bu yazıda karın ağrısı, ateş, halsizlik şikayetleri ile başvuran ve XGP tanısı alan altı yaşında kız hastadan bahsedildi. Özgeçmişinde tekrarlayan idrar yolu enfeksiyonu öyküsü mevcuttu. İdrar incelemesinde lökositüri, hematüri, nitrit ve bakteri pozitifliği mevcuttu. Laboratuvar analizinde beyaz kan hücresi: 12,7x103 /mikrol, hemoglobin:6,2 g/dl ve CRP: 101 mg/dl saptandı. Üriner sistem ultrasonda sol böbreğin konturları düzensiz ve lobüler olup, medüller punktat ekojenite ve kalsifikasyonlar mevcuttu. Kontrastlı abdominal bilgisayarlı tomografide sol böbrek boyutunda artış ve toplayıcı sistemde taşı düşündüren opasiteler görüldü; pararenal alan heterojendi. Hastanın gentamisin tedavisi 7 güne, meropenem tedavisi 14 güne tamamlanmasına rağmen akut faz reaktanlarında gerileme olmadı. Renal kortikal sintigrafide sol böbrek lojunda aktivite tutulumu gözlenmedi. Fonksiyone olmayan sol böbrek ve kronik piyelonefrit ön tanıları ile hastaya total nefrektomi uygulandı. Böbrek biyopsi materyali XGP ile uyumlu idi. XGP, nefrektomi gereksinimi gibi ciddi sonuçları olan kronik piyelonefritin nadir ve agresif bir nedenidir. Akut faz reaktanlarında beklenen düşüş sağlanamayan ve piyürisi devam eden çocuklarda ayırıcı tanıda düşünülmelidir.

Keywords

• Kronik piyelonefrit
• Piyelonefrit
• Üriner sistem enfeksiyonu
• Ksantogranulomatöz Piyelonefrit
• KGP

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