Home About us Current issue Back issues Submission Instructions Advertise Contact Login   

Search Article 
  
Advanced search 
 
Saudi Journal of Kidney Diseases and Transplantation
Users online: 233 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
 

LETTER TO EDITOR Table of Contents   
Year : 2005  |  Volume : 16  |  Issue : 3  |  Page : 334-335
Xanthogranulomatous like Pyelonephritis with no Xanthoma Cells: Should these Always be Present?


Kanoo Kidney Center, Dammam Central Hospital, P.O. Box 12723, Dammam 31483, Saudi Arabia

Click here for correspondence address and email
 

How to cite this article:
Malik TQ, Joseph Y T, Ghacha R, Abdelrahman M, Karkar A. Xanthogranulomatous like Pyelonephritis with no Xanthoma Cells: Should these Always be Present?. Saudi J Kidney Dis Transpl 2005;16:334-5

How to cite this URL:
Malik TQ, Joseph Y T, Ghacha R, Abdelrahman M, Karkar A. Xanthogranulomatous like Pyelonephritis with no Xanthoma Cells: Should these Always be Present?. Saudi J Kidney Dis Transpl [serial online] 2005 [cited 2020 Sep 22];16:334-5. Available from: http://www.sjkdt.org/text.asp?2005/16/3/334/32864
To the Editor:

We recently experienced an uncommon picture of a rare form of pyelonephritis. A 55 year old Indonesian woman, who had been living in Saudi Arabia for 35 years, and who had been unwell for 5 months, was admitted with fever, abdominal pain, dysuria and loss of weight. She had no history of hypertension, diabetes mellitus or analgesic abuse, but had repeated urinary tract infections and the patient passed urinary stones twice previously.

At presentation to our hospital temperature was 38.2°C, pulse rate 100/mm, and blood pressure 100/70mmHg. She had a moderate and tender hepatomegaly and left renal angle very tender. Laboratory showed: Hemoglobin: 10.6g/dl, with fragmented red blood cells. White blood cell count: 22000, Platelets count: 9000, BUN: 350 mg/dl, Serum Creatinine: 8.10 mg/dl, Serum Bilirubin: 7.8 mg/dl, GOT: 227, GPT: 350, Fibrinogen: 121mg/dl, FDP: 7500 mg/dl, K: 6.7 mmol/l, Urinalysis: several pus and red blood cells. The patient was admitted as a case of acute pyelonephritis complicated by septicemia, disseminated intravascular coagu­lation and acute renal failure. She was treated with IV fluids and antibiotics, received platelets trans-fusion and was commenced on hemo­dialysis. Plain x - ray showed left ureteric calcifications. Abdominal ultrasound revealed an enlarged left kidney with thickened (3 cm) hypoechoic cortex and dilated calyces. There was also a left ureterohydronephrosis with stones in the pelvis and ureter. CT scan showed an enlarged left hydronephrotic kidney with distorted architecture. The capsule and Gerota's fascia were thickened. There were collections in the perinephric area and in the retroperitoneal space. Blood and urine culture yielded Escharecia coli. After stabili­zation, the patient underwent an eventful left nephrectomy. The resected kidney weighted 375gr and measured 16cm x 8cm x 6cm. There were stones in the pelvis. On cut section, the cortex was granular and covered with purulent exudates and multiple abcesses and necroses. There was no demarcation between the cortex and the medulla. Microscopically, the sections showed multiple granulomas with many plasma cells, neutrophils, necrotic debris, but the typical PAS positive xanthoma cells were not seen.

The patient middle aged Asian lady presented with a renal inflammation and features of xanthogranulomatous pyelonephritis, a special and uncommon form of urinary tract infect­ion [1],[2] but the histological hallmark of the disease, the xanthoma cells were missing [3] despite adequate processing of the patho­logical specimen.

This case raises some important questions such as did these xanthoma cells undergo lysis as the disease was very severe? Is the presence of these xanthoma cells as sine qua non for the diagnosis?[4]

 
   References Top

1.Goodman M, Curry T, Russell T. Xantho­granulomatous pyelonephritis (XGP): A local disease with systemic manifestations. Report of 23 patients and review of the literature. Medicine 1979;58:171-5.  Back to cited text no. 1    
2.Stam F, van den Tillaar PL, Falke TH, Gans RO, ter Wee PM. Xanthogranulomatous pyelonephritis. Nephrol Dial Transplant 1995;10:2365-7.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Kelly DR, Murand TM. Megalocytic interstitial nephritis, xanthogranulomatous pyelonephritis and malakoplakia. An ultra­structural comparison. Am J Clin Pathol 1981;75:333-44.  Back to cited text no. 3    
4.Brown PS Jr, Dodson M, Weintrub PS. Xanthogranulomatous pyelonephritis: report of nonsurgical management of a case and review of the literature. Clin Infect Dis 1996;22:308-14.  Back to cited text no. 4    

Top
Correspondence Address:
Tahir Qayyum Malik
Kanoo Kidney Center, Dammam Central Hospital, P.O. Box 12723, Dammam 31483
Saudi Arabia
Login to access the Email id


PMID: 17642802

Rights and Permissions




 

Top
 
 
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    References
 

 Article Access Statistics
    Viewed1522    
    Printed44    
    Emailed0    
    PDF Downloaded195    
    Comments [Add]    

Recommend this journal