Xanthogranulomatous pyelonephritis: Presentation and surgical complications.

Abstract

To review & evaluate the clinical presentation & surgical complications of Xanthogranulomatous Pyelonephritis (XGP). Objectives: XGP is usually considered as an uncommon destructive chronic inflammatory disease of the kidney. The disease is usually diagnosed only on postoperative histopathological reports of the surgically excised tissues and has given less emphasis on preoperative diagnosis. We retrospectively reviewed biopsy proven diagnosed cases of XGP over the past 7 years, with a specific emphasis on preoperative clinical presentation of the patients, to help improve the preoperative diagnosis of XGP. Study Design: Case Series study. Setting: Department of Urology Sandeman Provincial Teaching Hospital Quetta. Period: 7 years July, 2011 to June, 2018. Material & Methods: We retrospectively reviewed all biopsy proven cases of XGP who underwent surgery in the department of Urology of a tertiary care hospital from July, 2011 to June, 2018 regarding clinical characteristics, laboratory & radiological finding, interoperate & postoperative complications. Results: There were 42 patients of XGP. The mean age was 49.8+-16.04 years. Male & female percentage was 40.50 & 59.50 respectively. Majority (88.1%) of patients were of low socio-economic status. The most common presentation was flank pain in 100% patients. Fever & dysuria in 64.28%, anorexia in 85.71% and weight loss in 83.33%. In laboratory findings, pyuria was present 88.09%, anemia in 71.42%, azotemia & abnormal liver enzymes in 14.29% each. The most common associated conditions were renal calculi in 83.33% and diabetes in 47.61%. The commonest organism isolated on culture was E-Coli in 35.48%. Intra-operatively excessive bleeding occurred in 3(7.14%), including one with tear of inferior vena cava. Two patients suffered colonic injury & another one pleural injury. Postoperatively the common complications were, wound infections in 8(19.04%) patients & Incisional hernia in 2(4.76%) patients. Conclusion: Urolithiasis and urinary tract infection are two well known risk factors for the development of XPN. Our experience in the present series, demonstrates that low socioeconomic status could be another risk factor for XPN. Early diagnosis and proper treatment of urolithiasis & urinary tract infection is important to prevent their complications including XGP.