Journal of Postgraduate Medicine
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Year : 1989  |  Volume : 35  |  Issue : 4  |  Page : 215-6  

Ureteral involvement in stage I xanthogranulomatous pyelonephritis--(a case report).

AK Mandal, KK Vaiphei, SR Bhusnurmath, SS Vaidyanathan 
 

Correspondence Address:
A K Mandal


Abstract

A case of xanthogranulomatous pyelonephritis (Stage-I: Nephric) with ureteral involvement is described. The patient had undergone right nephrectomy with the working diagnosis of calculus pyonephrosis and non-functioning kidney. Histopathological examination of the nephrectomy specimen revealed xanthogranulomatous pyelonephritis confined to the kidney and non-contiguous involvement of ureter. Post-operative recovery was uneventful and there had been no evidence of disease recurrence till one year«SQ»s follow-up.



How to cite this article:
Mandal A K, Vaiphei K K, Bhusnurmath S R, Vaidyanathan S S. Ureteral involvement in stage I xanthogranulomatous pyelonephritis--(a case report). J Postgrad Med 1989;35:215-6


How to cite this URL:
Mandal A K, Vaiphei K K, Bhusnurmath S R, Vaidyanathan S S. Ureteral involvement in stage I xanthogranulomatous pyelonephritis--(a case report). J Postgrad Med [serial online] 1989 [cited 2020 Nov 27 ];35:215-6
Available from: https://www.jpgmonline.com/text.asp?1989/35/4/215/5682


Full Text



 INTRODUCTION



Ureteral involvement in xanthogranulomatous pyelonephritis (XGP) appears to be very rare as it has not been mentioned in recent review articles on the subject.[1],[2],[3],[5] We herein report a case of XGP localised to the kidney, yet involving the ureter by the xanthogranulomatous process.

 CASE REPORT



A 55 year old male presented with intermittent fever and pyuria of one year's duration. He developed a discharging sinus following incision and drainage of the right flank abscess, one month back. Ten years ago, he had undergone right pyelolithotomy. Physical examination revealed a moderately nourished individual, with a discharging right flank sinus, just below the scar of the previous operation and a firm, tender mass in the right renal area. Hemogram, blood urea, serum creatinine, liver function tests and skiagram of the chest were normal. Erythrocyte sedimentation rate was 32 mm (First hour, Westergren). Urinary sediment showed many pus cells. The cultures of the sinus-discharge and urine revealed growth of mixed contaminants and were negative for acid fast bacilli. X-ray of the KUB region showed multiple, irregular, radioopacities in the right renal area. Ultrasonography revealed an enlarged and hydronephrotic right kidney with multiple calculi in it. Intravenous urography showed normal left reno-ureteral unit. The right kidney was not visualised even in delayed films. Biopsy from the sinus tract showed a picture of non-specific chronic inflammation.

A right flank exploration revealed pus pockets in the kidney in direct communication with the flank sinus. A right nephrectomy and excision of the sinus tract was performed. The postoperative recovery was uneventful. Cut surface of the kidney revealed multiple pus pockets, scattered areas of hard, yellow granulomatous material, multiple phosphatic calculi and no identifiable healthy renal parenchyma. Microscopic examination confirmed the diagnosis of xanthogranulomatous pyelonephritis with foci of granulation tissue containing ieucocytes, lipid-laden mononuclear macrophages and multiple foreign body giant cells. The renal capsule and perinephric fat showed chronic inflammatory cellular infiltrates but were not involved by the xanthogranulomatous process. Sections from the ureter showed ulceration of the lining epithelium and inflammatory cell infiltrate, characteristic of xanthogranulomatous process [Figs. 1] and [Fig 2].

 DISCUSSION



Malek et al[2] has classified XGP into three stages: (i) nephric; (ii) nephric and perinephric; and (iii) nephric, perinephric, and paranephric. In the present case, the xanthogranulomatous process was localised to the kidney (Stage I: Nephric); yet there was non-contiguous involvement of the ureter. Remigio et al[4] reported a case of xanthogranulomatous ureteritis, managed by excision of the terminal segment of the ureter and ureteroneocystostomy. In the present case, only nephrectomy was done as xanthogranulomatous involvement of the ureter was diagnosed on histopathology. The wound had healed without any sinus formation; there has been no evidence of recurrence of the disease during the one year follow-up. Recurrences of XGP were never documented contralaterally, or ipsilaterally in case of conservative procedures.[5] In conclusion, non-contiguous involvement of the ureter in XGP may occur which, however, may not necessitate excision of the ureteral stump.

References

1Cohen, M. S.: Granulomatous nephritis. Urol. Clin. North Amer., 13: 647-659, 1986.
2Malek, R. S., Greene, L. F., DeWeerd, J. If. and Farrow, G. M.: Xanthogranulomatous pyelonephritis. Brit. J. Urol., 44: 296-308, 1972.
3Oosterhof, G. O. and Delaere, K. P.: Xanthogranulomatous pyelonephritis, A review with 2 case reports. Urol. Int , 41: 180-186. 1986.
4Remigio, P., Ramos, C. and Basirico, P.: Xanthogranulomatous ureteritis. J. Urol., 114: 621-623, 1975.
5Rosi, P., Selli, C., Carini, M., Rosi, M. F. and Mottola, A.: Xanthogranulomatous pyelonephritis: clinical experience with 62 cases. Eur. Urol., 12: 96-100, 1986.

 
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