XANTHOGRANULOMATOUS PYELONEPHRITIS- A RARE CASE REPORT

An unusual type of the long-lasting pyelonephritis demonstrating a long-lasting granulomatous disease resulting in a non-functional kidney in the patient is generally linked with xanthogranulomatous pyelonephritis. The name itself suggests this involves a granulomatous progression that is chronic, due to a chronic or sub-acute infection in the patient inciting a chronic but incomplete immune reaction in the individual. Different bacteria are generally known to be identified, but the most commonly associated species are Escherichia coli and Proteus mirabilis. Clinical presentation of the patient suffering from the disease is typically unclear, consisting of symptoms like malaise, loss of weight and low-grade fever and loss of appetite. Blood in the urine (hematuria) and flank pain are generally presented in the patients with the disease. Urinary tract symptoms may not be present always, but pus in the urine and positive urinary cultures are present in many of the cases of the patients (95 and 60% respectively). The disease finally results in the replacement of the kidney by a mass of reactive tissue, provoking staghorn calculus with associated hydronephrosis to any of the gradations. Foamy macrophages that are lipid-laden generally prevail. The inflammatory process eventually extends into perinephric tissues and even adjacent organs of the body. MRI, CT scan, ultrasound examination helps in diagnosing the disease. Management includes partial or complete nephrectomy and antibiotics. In this case report, we will include a case of severe xanthogranulomatous pyelonephritis managed with nephrectomy.