Xanthogranulomatous pyelonephritis

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[edit] Discussion of Xanthogranulomatous pyelonephritis

  • Xanthogranulomatous pyelonephritis (XGP) is a rare inflammatory condition usually secondary to chronic obstruction caused by nephrolithiasis and resulting in infection and irreversible destruction of the renal parenchyma.
  • XGP is associated with a staghorn calculus in approximately 70% of cases.
  • Patients with diabetes are particularly predisposed to the formation of XGP.
  • Treatment is with nephrectomy.
  • At histologic analysis, the inflammatory mass is composed of lipid-laden macrophages and chronic inflammatory cells.

[edit] Imaging Findings of Xanthogranulomatous pyelonephritis

  • Classic urographic triad in diffuse xanthogranulomatous pyelonephritis consists of unilaterally decreased or (more commonly) absent renal excretion, a staghorn calculus, and a poorly defined mass or diffuse renal enlargement.

  • At sonography, the inflammatory mass itself is hypoechoic, with central echogenic foci corresponding to renal calculi.

  • The CT findings of xanthogranulomatous pyelonephritis are pathognomonic in most cases: diffuse reniform enlargement with ill-defined central low attenuation, apparent cortical thinning, and central calculi.
    • Extension into the perinephric space and beyond the Gerota fascia is not uncommon.
    • Central areas of low attenuation represent nonenhancing xanthomatous material that may demonstrate attenuation values less than those of water.

[edit] Images

Patient #1: CT images demonstrate right xanthogranulomatous pyelonephritis

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