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Year : 2013  |  Volume : 23  |  Issue : 5  |  Page : 388--389

Unilateral xanthogranulomatous pyelouretritis with a functioning kidney

MK Mittal, B Sureka, M Sinha, BB Thukral 
 Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

Correspondence Address:
B Sureka
Department of Radiodiagnosis, VMMC and Safdarjung Hospital, Resident Doctors Hostel, Room 57, New Delhi 110 029
India

How to cite this article:
Mittal M K, Sureka B, Sinha M, Thukral B B. Unilateral xanthogranulomatous pyelouretritis with a functioning kidney.Indian J Nephrol 2013;23:388-389

How to cite this URL:
Mittal M K, Sureka B, Sinha M, Thukral B B. Unilateral xanthogranulomatous pyelouretritis with a functioning kidney. Indian J Nephrol [serial online] 2013 [cited 2022 Aug 15 ];23:388-389
Available from: https://www.indianjnephrol.org/text.asp?2013/23/5/388/116340

Full Text

A 36-year-old male presented to the emergency department with left flank pain, intermittent hematuria and dysuria for 20 days. On examination, he was drowsy and afebrile, with a pulse rate of 76/min, blood pressure of 140/80 mmHg and respiratory rate of 16/min. Laboratory investigations revealed raised erythrocyte sedimentation rate (ESR) and normal renal function. Urinalysis showed microscopic hematuria with few pus cells.

Ultrasonography revealed normal-sized kidneys with moderate hydronephrosis of the left kidney. Renal pelvis showed a large calculus measuring 2.5 cm ( 2 cm. Homogenous echogenic areas were seen in the renal pelvis and proximal periureteric region [Figure 1]. Right kidney and urinary bladder were normal. Contrast-enhanced computed tomography showed normal-sized and normally functioning kidneys. Calculus was seen in the left renal pelvis with moderate hydronephrosis. The renal pelvis) and proximal ureter showed thickening and enhancement of its wall with surrounding thick rim of fat-attenuating component (−85 to − 100 HU) [Figure 2]. A magnetic resonance imaging showed circumferential layers of varying signal intensity on axial scans and calculus as a signal void in the center. The intermediate granulation tissue showed enhancement in the left renal pelvis and periureteric region. The peripheral hyperintense rim on T1 was suppressed on the fat sat sequence, confirming its lipid nature [Figure 3]. Based on these imaging findings, a diagnosis of xanthogranulomatous etiology was considered.{Figure 1}{Figure 2}{Figure 3}

The patient underwent left nephroureterectomy. Histopathological report was xanthogranulomatous pyelouretritis. Microscopic examination showed abundance of lipid-laden macrophages, lymphocytes, and plasma cells [Figure 4]. The renal parenchyma was unaffected.{Figure 4}

Xanthogranulomatous pyelouretritis is an extremely rare entity with only two cases described in the literature. [1],[2] The renal parenchyma is normal in morphology and function in xanthogranulomatous pyelouretritis. Lipid-laden macrophage and inflammatory process is confined to the renal pelvis and ureter. [1]

Differentiation of xanthogranulomatous pyelouretritis from xanthogranulomatous pyelonephritis (XGP) may be difficult. Once the diagnosis is confirmed, the goal is to remove all the involved granulomatous tissue. If this is not accomplished, the remaining infected tissue may lead to formation of cutaneous fistulae. When the disease is confined to the ureter, partial ureterectomy is performed. When the process involves the kidneys, partial or total nephroureterectomy is performed according to the severity of involvement.

References

1Remigio P, Ramos C, Basirico P. Xanthogranulomatous ureteritis. J Urol 1975;114:621-3.
2Sharma S, Jhobta A, Goyal D, Surya M, Sumala, Negi A. Ureteral involvement in xanthogranulomatous pyelonephritis - Rare manifestation. Indian J Radiol Imaging 2006;16:243-5.