A 57-year-old woman with a past medical history of chronic kidney disease stage III,
recurrent urinary tract infections (UTIs), and recurrent kidney stones, presented
with complaints of fever, flank pain, and dysuria. On physical exam, the abdomen was
soft, slightly tender and without palpable masses. Serum creatinine was elevated at
2.4 mg/dL. Ceftriaxone was initiated for likely recurrent UTI; however, urine culture
grew <10k E. coli colony-forming units and blood cultures demonstrated no growth after
5 days. A CT abdomen and pelvis with intravenous contrast showed severe left-sided
hydronephrosis with renal cortical thinning, dilated renal calyces (Figs. 1A, 1B) and non-obstructing calculi in the collecting system. Right kidney had prominent
calyces present. CT also demonstrated lack of renal excretion of contrast material
after a 20 min delay, indicative of a non-functioning kidney. The findings were consistent
with xanthogranulomatous pyelonephritis. She underwent a nephrectomy. Gross pathology
exam demonstrated an enlarged kidney with dilated calyceal system (Fig. 2A). Histopathology revealed chronic pyelonephritis with lipid-laden macrophages (Fig. 2B). After surgery, the patient was left with an estimated glomerular filtration rate
of 40-45 mL/min/BSA.
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References
- Xanthogranulomatous pyelonephritis: a pathological, clinical and aetiological analysis of 87 cases.Diagn Histopathol. 1983; 6: 203-219
- Bear's paw sign: a classic presentation of xanthogranulomatous pyelonephritis.Urology. 2015; 86: e5-e6
Article info
Publication history
Published online: February 02, 2022
Accepted:
January 26,
2022
Received:
April 15,
2021
Identification
Copyright
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
