Hamide SAYAR, Tayfun ŞAHİNKANAT, Mesut ÖZKAYA, Önder MALKOÇ, Bülent ALTINOLUK

Xanthogranulomatous pyelonephritis presented with spontaneous kidney rupture in a young woman

Ksantogranülomatöz pyelonefrit (XGP), renal parankimin nadir görülen ve agresif seyreden, özellikle diffüz renal yıkım ile sonuçlanan enflamasyonudur. Daha önceden sağlıklı olan 25 yaşında kadın hasta kliniğimize, ani başlangıçlı sağ flank ağrısı, bulantı ve yüksek ateş ile başvurdu. Bilgisayarlı tomografi sağ böbrek etrafında, pelvis ve paravertebral alana uzanım gösteren12 x 7 cm çapında bir kitle izlenimi gösterdi. Bunun üzerine acil olarak flank insizyon yapıldı ve sağ böbreğin posterior yüzünde lokalize rüptürden kaynaklanan oldukça büyük perirenal hematom ve abse formasyonu bulundu. Sağ nefrektomi yapıldı ve perirenal alan- dan abse materyali boşaltıldı. XGP tanısı, çıkarılan böbreğin histopatolojik incelemesiyle konuldu. XGP, progresyon gösteren ve nonspesifik semptomlarla seyreden bir durum olmasına rağmen, bizim vakamızda olduğu gibi komplikasyon ile de ortaya çıkabilir. Hastamız renal rüptür ve paravertebral alana ve pelvise uzanım gösteren perirenal abse ile başvurdu. Bizim bilgimize göre, bu olgu literatürde spontan renal rüptür ile başvuran ilk XGP olgusudur.

Genç bir kadında spontan böbrek rüptürü ile seyreden ksantogranülomatöz pyelonefrit

Xanthogranulomatous pyelonephritis (XGP) is an uncommon and aggressive form of inflammation of the renal parenchyma par- ticularly resulting in diffuse renal destruction. A previously healthy 25-year-old woman was admitted to our clinic with right flank pain of sudden onset, nausea and high fever. Computed tomography revealed a mass (12 x 7 cm in diameter) around the right kidney with extension to pelvis and paravertebral space. Flank incision was made urgently and a very large perirenal haematoma and abscess formation were found caused by the rupture located at the posterior side of the right kidney. A right nephrectomy was performed and abscess material was evacuated from the perirenal area. XGP was diagnosed by histopathologic examination of the resected kidney. Although XGP regularly demonstrates a gradual progression and presents with nonspecific symptoms, the situation may appear with complications as in our case. Our patient presented with renal rupture and perirenal abscess extending to the pelvis and paravertebral space. To the best of our knowledge, this is the first report of XGP presenting with spontaneous renal rupture in the English literature.

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