Q: 42 years old male with a past medical history of kidney transplant is admitted to ICU with septic shock due to an underlying kidney infection. Patient gets diagnosed with xanthogranulomatous pyelonephritis (XPN). Broad-spectrum antibiotics started. Surgical service should be consulted for en-bloc nephrectomy?
A) True
B) False
Answer: A
Xanthogranulomatous pyelonephritis is usually unilateral and results in massive kidney destruction, except in the pediatric population, where it can be localized. Antibiotics are indicated due to infectious processes, but most patients need en-bloc nephrectomy, where fistula formations may also require repair.
Pediatric patients with localized disease may get away with partial nephrectomy. Rarely, in some adult patients who develop bilateral disease, a surgeon may decide to avoid full nephrectomies to preserve kidney function.
XPN may confuse clinicians on bedside ultrasound as renal cell carcinoma. It is called Xanthogranulomatous pyelonephritis because, microscopically, there are granulomas and lipid-laden macrophages (hence the term xantho = yellow).
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References:
2. Peréz LM, Thrasher JB, Anderson EE. Successful management of bilateral xanthogranulomatous pyelonephritis by bilateral partial nephrectomy. J Urol 1993; 149:100.
3. Guzzo TJ, Bivalacqua TJ, Pierorazio PM, et al. Xanthogranulomatous pyelonephritis: presentation and management in the era of laparoscopy. BJU Int 2009; 104:1265.
4. Parsons MA, Harris SC, Grainger RG, et al. Fistula and sinus formation in xanthogranulomatous pyelonephritis. A clinicopathological review and report of four cases. Br J Urol 1986; 58:488.
5. Hitti W, Drachenberg C, Cooper M, et al. Xanthogranulomatous pyelonephritis in a renal allograft associated with xanthogranulomatous diverticulitis: report of the first case and review of the literature. Nephrol Dial Transplant 2007; 22:3344.
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