Leoni Francisco Alberto, Kinleiner Pablo, Revol Martín, Zaya Alejandro, Odicio Alejandro
Hospital Aeronáutico Córdoba, Argentina.
Arch Esp Urol. 2009 May;62(4):259-71. doi: 10.4321/s0004-06142009000400001.
To report our experience with clinical presentation, appearance, diagnosis and treatment of Xanthogranulomaous pyelonephritis (XP).
Multicenter, observational, descriptive and retrosprospective study carried out during six years.
We studied 10 patients, 8 women and 2 males, with an average age of 50 years. All cases presented with lumbar and abdominal pain, loss of weight, conjuntival pallor, renal lithiasis and chronic evolution Fever and palpable abdominal mass, were present in 80% of cases and 60% presented history of urinary tract infection. Initial diagnosis, in most cases, was pyonephrosis. Two cases (20 %). were associated with cancer and other 2 (20 %)with Psoriasis. Mortality was of (10 %).Laboratory hallmark were anemia, high SGV rate and leukocytosis. Urinary sediment showed pyuria. Urine culture was positive in the 50 % of the patients. On the other hand urine cultures obtained from nephrostomy tube were always positive. The onset was unilateral and diffuse in all cases without predominance in the location. Direct abdominal x-ray showed lithiasis, ultrasound showed increased renal size, with a pattern of hydronephrosis and/or intraparenchymatous abscesses. CT scan was useful to demonstrate disease extension.
Xanthogranulomatous pyelonephritis (XP) is a chronic and unusual inflammatory-infectious disease with acute episodes involving renal parenchyma. Most cases appear in medium aged women. Histopathologic study offers the accurate diagnosis. Antibiotic therapy avoids septic complications. Total or partial nephrectomy is the definitive treatment. We propose nephrostomy because it facilitates the microbiological diagnosis and surgery (nephrectomy).
报告我们关于黄色肉芽肿性肾盂肾炎（XP）临床表现、外观、诊断及治疗的经验。
进行了为期六年的多中心、观察性、描述性及回顾性研究。
我们研究了10例患者，8名女性和2名男性，平均年龄50岁。所有病例均有腰腹痛、体重减轻、结膜苍白、肾结石及慢性病程。80%的病例有发热及可触及的腹部肿块，60%有尿路感染病史。多数病例的初始诊断为肾积脓。2例（20%）合并癌症，另外2例（20%）合并银屑病。死亡率为10%。实验室特征为贫血、高SGV率及白细胞增多。尿沉渣显示脓尿。50%的患者尿培养阳性。另一方面，从肾造瘘管获取的尿培养总是阳性。所有病例起病均为单侧且弥漫性，无部位优势。腹部直接X线显示结石，超声显示肾脏增大，呈肾积水和/或实质内脓肿表现。CT扫描有助于显示疾病范围。
黄色肉芽肿性肾盂肾炎（XP）是一种慢性且不常见的炎症性感染疾病，有累及肾实质的急性发作。多数病例见于中年女性。组织病理学研究可提供准确诊断。抗生素治疗可避免败血症并发症。全肾或部分肾切除术是确定性治疗方法。我们建议行肾造瘘术，因为它有助于微生物学诊断及手术（肾切除术）。
