Background. Xanthogranulomatous pyelonephritis is characterized by the inflammatory destruction of the renal parenchyma and intensive renal fibrosis. It is named because of its pathological appearance; that of its granulomatous inflammatory process with lipid-laden macrophages, which appear yellow, hence ‘xantho’ which is Greek for yellow. Xanthogranulomatous pyelonephritis is predominantly a disease of adults. In children it is diagnosed sporadically and is extremely rare in infants. The age of onset varies (21 days to 16 years), although 60-75% of cases have been diagnosed before 5 years of age. Recurrent urinary tract infections, obstructive nephropathy caused by renal calculus, malnutrition, abnormal lipid metabolism, altered immunologic response, lymphatic blockage, congenital urinary anomalies have been implicated in the etiology of xanthogranulomatous pyelonephritis in children. Case. We report an unusual case of xanthogranulomatous pyelonephritis in a 5-year-old girl and discuss its clinical features, histopathological findings and treatment. In this article, we also emphasized the importance of diagnostic imaging in urinary tract infections which enabled us not to miss the underlying kidney stone disease. Conclusion. Nephrolithiasis may lead to very serious conditions such as xanthogranulomatous pyelonephritis. This condition can be easily diagnosed by ultrasound, but if not detected, it can lead to complete loss of renal function as in the case.
___
1. Sangüesa Nebot C, Pico Aliaga S, Serrano Durba A, Roca MJ. Xantogranulomatous pyeloneprhritis in children. Insights Imaging 2018; 9: 643-651.
2. Addison B, Zargar H, Lilic N, Merrilees D, Rice M. Analysis of 35 cases of xanthogranulomatous pyelonephritis. ANZ J Surg 2015; 85: 150-153.
3. Samuel M, Duffy P, Capps S, Mouriquand P, Williams D, Ransley D. Xanthogranulomatous pyelonephritis in childhood. J Pediatr Surg 2001; 36: 598-601.
4. Li L, Parwani AV. Xanthogranulomatous pyelonephritis. Arch Pathol Lab Med 2011; 135: 671- 674.
5. Zugor V, Schott GE, Labanaris AP. Xanthogranulomatous pyelonephritis in childhood: a critical analysis of 10 cases and of the literature. Urology 2007: 70: 157-160.
6. Quinn FMJ, Dick AC, Corbally MT, McDermott MB, Guiney EJ. Xanthogranulomatous pyelonephritis in childhood. Arch Dis Child 1999; 81: 483-486.
7. Bingol-Kologlu M, Ciftci AO, Senocak ME, Tanyel FC, Karnak I, Buyukpamukcu N. Xanthogranulomatous pyelonephritis in children: diagnostic and therapeutic aspects. Eur J Pediatr Surg 2002; 12: 42- 48.
8. Braun G, Moussali L, Balanzar JL. Xanthogranulomatous pyelonephritis in children. J Urol 1985; 133: 236-239.
9. Clapton WK, Boucaut HAP, Dewan PA, Bourne AJ, Byard RW. Clinicopathological features of xanthogranulomatous pyelonephritis in infancy. Pathology 1993; 25: 110-113.
10. Hammadeh MY, Nicholls G, Calder CJ, Buick RG, Gornall P, Corkery JJ. Xanthogranulomatous pyelonephritis in childhood: pre-operative diagnosis is possible. Br J Urol 1994; 73: 83-86.