Pais João Sakuray, Rocha Mirelle Barbosa, Muglia Valdair Francisco, Chahud Fernando, Molina Carlos Augusto Fernandes, Ruellas Heitor Ramos, Tucci Silvio Junior
Department of Surgery and Anatomy, Division of Urology, Ribeirão Preto Medical School, University of São Paulo, Brazil.
Department of Medical Images, Hematology and Clinical Oncology, Division of Radiology, Ribeirão Preto Medical School, University of São Paulo, Brazil.
Urol Ann. 2022 Oct-Dec;14(4):383-388. doi: 10.4103/ua.ua_180_21. Epub 2022 Sep 7.
Xanthogranulomatous pyelonephritis (XGP) is a chronic and severe infection of the kidney. We aimed to review the main clinical, imaging, and histological findings and to assess predictors of surgical complications or hospitalization >10 days (no deaths reported).
We retrospectively searched all patients with XGP treated at our institution from 2005 to 2019, with 57 patients enrolled. Clinical data were retrieved by a single reader, computed tomographic (CT) examinations by two radiologists, and histopathological specimens by an experienced pathologist.
The patients' mean age was 44.3 ± 16.2 years and 41 (71.9%) were female. The most common symptoms were flank/lumbar pain (89.5%), fever (43.9%), and recurrent urinary tract infection (43.9%). The mean time until the presumptive diagnosis was 365.1 days and the median hospitalization period was 11 days. Blood tests showed anemia (78.9%), leukocytosis (43.6%) with left shift (21.6%). Urinalysis showed hematuria (75.6%), bacteriuria (40.9%), and leukocytes (93.2%). Urine cultures showed in 14.8%, in 7.4%, while 59.3% were negative. Of 40 patients with CT examinations, 38 (95%) presented with hydronephrosis and perinephric inflammatory changes (PIC) and 22 (55%) with Bear Paw sign. PIC was the only independent predictor at multivariate analysis for surgical complications. For prolonged hospitalization, fever and PIC were independent predictors at univariate, but only fever at multivariate analysis.
XGP is a worrisome condition, with unclear pathophysiological mechanisms. Fever and PIC at CT examinations were predictors of poor outcomes.
黄色肉芽肿性肾盂肾炎（XGP）是一种慢性严重的肾脏感染。我们旨在回顾主要的临床、影像学和组织学表现，并评估手术并发症或住院时间超过10天（未报告死亡病例）的预测因素。
我们回顾性检索了2005年至2019年在我院接受治疗的所有XGP患者，共纳入57例患者。临床数据由一名阅片者检索，计算机断层扫描（CT）检查由两名放射科医生进行，组织病理学标本由一名经验丰富的病理学家检查。
患者的平均年龄为44.3±16.2岁，41例（71.9%）为女性。最常见的症状是胁腹/腰痛（89.5%）、发热（43.9%）和反复尿路感染（43.9%）。推定诊断前的平均时间为365.1天，中位住院时间为11天。血液检查显示贫血（78.9%）、白细胞增多（43.6%）伴核左移（21.6%）。尿液分析显示血尿（75.6%）、菌尿（40.9%）和白细胞（93.2%）。尿培养显示14.8%为[具体细菌名称1]，7.4%为[具体细菌名称2]，而59.3%为阴性。在40例接受CT检查的患者中，38例（95%）表现为肾积水和肾周炎症改变（PIC），22例（55%）表现为熊掌征。在多因素分析中，PIC是手术并发症的唯一独立预测因素。对于延长住院时间，发热和PIC在单因素分析中是独立预测因素，但在多因素分析中只有发热是独立预测因素。
XGP是一种令人担忧的疾病，其病理生理机制尚不清楚。CT检查时的发热和PIC是不良预后的预测因素。
