Quinn F M, Dick A C, Corbally M T, McDermott M B, Guiney E J
Department of Surgery, Our Lady's Hospital for Sick Children, Crumlin, Dublin 12, Republic of Ireland.
Arch Dis Child. 1999 Dec;81(6):483-6. doi: 10.1136/adc.81.6.483.
Xanthogranulomatous pyelonephritis is a severe, atypical form of chronic renal parenchymal infection accounting for 6/1000 surgically proved cases of chronic pyelonephritis. Its manifestations mimic those of neoplastic and other inflammatory renal parenchymal diseases and, consequently, it is often misdiagnosed preoperatively.
To examine the relation between clinical history and the results of renal investigations performed in children with xanthogranulomatous pyelonephritis.
A retrospective review of 31 cases presenting with the histopathological diagnosis of xanthogranulomatous pyelonephritis between 1963 and 1999.
The mean follow up was 8.2 years. The male:female ratio was 1:1.1. The left kidney was affected in 26 of the 31 patients. The positive findings on examination and investigation at presentation were: fever, 16 children; pyuria, 26 children; positive urine culture, 16 children. A haemoglobin of < 100 g/l was measured in 27 of 31 patients and 15 of 18 patients tested had a raised erythrocyte sedimentation rate of > 20 mm in the first hour. Twenty six children had renal calculi, with a large reduction in the function of the affected kidney on isotope scintigraphy in 27 of the 29 patients tested. Hypertrophy of the contralateral kidney, shown on imaging, was present in 17 of 31 patients.
Increasing awareness of this condition should lead to the diagnosis being suspected preoperatively.
黄色肉芽肿性肾盂肾炎是一种严重的、非典型的慢性肾实质感染，占手术证实的慢性肾盂肾炎病例的千分之六。其表现与肿瘤性及其他炎症性肾实质疾病相似，因此术前常被误诊。
探讨黄色肉芽肿性肾盂肾炎患儿的临床病史与肾脏检查结果之间的关系。
回顾性分析1963年至1999年间31例经组织病理学诊断为黄色肉芽肿性肾盂肾炎的病例。
平均随访8.2年。男女比例为1:1.1。31例患者中26例左侧肾脏受累。就诊时检查及调查的阳性结果为：发热16例；脓尿26例；尿培养阳性16例。31例患者中有27例血红蛋白<100g/L，18例接受检测的患者中有15例第一小时红细胞沉降率升高>20mm。26例患儿有肾结石，29例接受检测的患者中有27例患侧肾脏同位素闪烁扫描显示功能大幅减退。31例患者中有17例影像学显示对侧肾脏肥大。
提高对该病的认识应能在术前怀疑其诊断。
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