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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- Bear's paw sign: a classic presentation of xanthogranulomatous pyelonephritis.Urology. 2015; 86: e5-e6
Published online: February 02, 2022
Accepted: January 26, 2022
Received: April 15, 2021
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.