Xanthogranulomatous Pyelonephritis – Complicated UTIs

by Amy Sussman, MD

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    00:01 How about xanthogranulomatous pyelonephritis? This is a chronic destructive granulomatous inflammation of the renal parenchyma.

    00:10 It's associated with obstruction of the urinary tract and also infected renal stones.

    00:16 We see this most often in middle-aged women who have a history of UTI.

    00:21 The symptoms that they're going to present with include flank pain, fever, anorexia are not being hungry and weight loss.

    00:28 You can actually at times palpate a renal mass at the flank.

    00:32 Diagnosis again, we're going to see pyuria on our urine analysis and a positive urine culture.

    00:37 But again, this is where we want to get a CT scan of her patient.

    00:41 So here we can, so a CT scan is going to demonstrate enlarge two kidneys with multilocular appearance, perhaps a presence of stones.

    00:50 And then you're also going to see on CT this low-density mass that's xanthomatous tissue.

    00:55 So if you look here the image on the left is actually an axial cut of a CT scan through the kidneys and look at that left kidney.

    01:03 It's huge.

    01:04 It's multiloculated.

    01:06 This is that xanthogranulomatous inflammation, and if you look at those hypodensities there, that's the xanthomonas material.

    01:14 The next image beside it is actually a sagittal section of the CT scan and once again, you can see how large that kidney is and where those xanthomatous infiltrations are.

    01:23 There's also a calculus in the kidney as well.

    01:26 That's that bright hyperdensity.

    01:28 The microorganisms that are involved in causing xantho granulomatous pyelonephritis include E.coli, Proteus, pseudomonas aeruginosa, enterococcus, Klebsiella, and staph aureus.

    01:42 The treatment once again is going to include broad-spectrum parenteral antibiotics.

    01:47 Most likely patients will also need a total or at least a partial nephrectomy.

    01:52 So this once again, we'll be calling our Urological colleagues in order to help us out.

    About the Lecture

    The lecture Xanthogranulomatous Pyelonephritis – Complicated UTIs by Amy Sussman, MD is from the course Urinary Tract Infection (UTI).

    Included Quiz Questions

    1. It is associated with infected stones and urinary tract obstruction.
    2. It is characterized by acute destructive inflammation of the renal parenchyma.
    3. CT scan shows enlarged kidneys with high-density masses.
    4. Management includes broad-spectrum oral antibiotics and percutaneous drainage.

    Author of lecture Xanthogranulomatous Pyelonephritis – Complicated UTIs

     Amy Sussman, MD

    Amy Sussman, MD

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