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Xantogranulomatous diffuse pyelonephritis in infants

O. Bouali, H. Oumarou, K. Chaumoître, M. Panuel, P. Alessandrini, T. Merrot

North Hospital, Mediterranean University, Marseille, France

 

ABSTRACT

Introduction: Xantogranulomatous Diffuse Pyelonephritis (XDP) is a very rare infectious pathology in children.

Material and methods: We report the case of an 8 months old child, who presented an isolated mass in the left flank, without fever, without asthenia, discovered during the follow-up of a moderated left pelvic dilation of antenatal diagnosis (Society for Fetal Urology 2). There was a biological inflammatory syndrome and the urine bacteriology was negative. The imaging of the urinary tract (ultrasound and tomography) showed a non-functional “hydropyonephrotic” left kidney leading towards the diagnostic of XDP. We indicated left nephrectomy by lumbotomy. The kidney volume was increased with important perirenal infiltration and a pelviureteral junction stenosis.

Results: A total nephrectomy was performed and the anatomopathologic examination confirmed the XDP diagnosis. There were no complications during the postoperative 8 months follow-up.

Conclusion: The XDP is a rare and atypical form of chronic renal suppuration that determines renal parenchyma destruction, which is replaced by granulomatous tissue containing xantomatous cells. It presents under different clinical forms and the symptoms are not specific. The surgical treatment is curative. The positive diagnostic is made by the anatomopathologic examination of the nephrectomy specimen. Even if it is rare in the first year of life, one must think to the XDP diagnosis in case of renal mass associated to malformative uropathy.

 

Key words: xantogranulomatous diffuse pyelonephritis, nephrectomy