Xanthogranulomatous Pyelonephritis – Complicated UTIs

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.