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      Xanthogranulomatous pyelonephritis: a focus on microbiological and antibiotic resistance profiles

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          Abstract

          Background

          Xanthogranulomatous pyelonephritis (XGP) is an inflammatory condition of the kidney and its treatment most often involves a combination of antibiotics and nephrectomy. This study aimed to define the clinical features and management of XGP, focusing on microbiological aspects and antibiotic therapy.

          Methods

          We performed a retrospective study of 27 cases of XGP diagnosed between January 2001 and January 2020 to analyse their clinical and management characteristics. In addition, a literature review was conducted of XGP case series covering the period from 2000–2020. We searched PubMed for case series through April 2020 without language restrictions. Studies reporting case series of XGP (more than ten cases) were included if they were relevant to this study.

          Results

          Twenty-seven patients were diagnosed with XGP, and 26 of them were histologically proven to have XGP. A total of 81.5% of the patients were female and the mean age was 59.6 years (SD 19.2). The most frequent symptoms were flank pain (70.4%) and fever (59.3%), while 77.8% of patients had renal stones. Proteus mirabilis was detected in the urine culture in 18.5% of patients, followed by detection of Escherichia coli in 14.8% of patients. The computed tomography (CT) findings included perirenal (29.6%) or pararenal (29.6%) involvement in the majority of patients. Twenty-six patients underwent nephrectomy. Piperacillin/tazobactam and ceftriaxone were the most commonly prescribed antibiotics for treatment. The reported piperacillin/tazobactam and ceftriaxone resistance rates were 14.3% and 16.6%, respectively. Twenty-six case series were included in the literature review, reporting 693 cases in total.

          Conclusion

          We found well-established characteristics of XGP patients among series in terms of previous history, clinical, laboratory and imaging findings, and operative and postoperative outcomes. It is important to know the clinical presentation and potential severity of XGP, as well as the most frequently involved microorganisms and their antibiotic resistance profiles, to select the most appropriate antibiotic therapy.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12894-021-00800-z.

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          Xanthogranulomatous pyelonephritis: clinical experience with 41 cases.

          Marcos Broglio, Fernando Korkes, Silvana R. Favoretto … (2008)
          Xanthogranulomatous pyelonephritis (XGP) is an uncommon inflammation of the renal parenchyma that occurs in the presence of chronic obstruction and suppuration. In this retrospective study, a review of the features of 41 recent cases of XGP is presented and compared with current published data. We retrospectively evaluated the clinical, surgical, and radiologic features of 41 cases of XGP and compared the data of this Brazilian population with that from current published reports. XGP was diagnosed in 19.2% of all nephrectomies performed for pyelonephritis during the period analyzed. Of the 41 patients with XGP, 85.4% were women and 14.6% were men. All patients were symptomatic, and the most common symptoms were fever, flank or abdominal pain, weight loss, lower urinary tract symptoms, and gross hematuria. The most frequent computed tomography findings included hydronephrosis, kidney enlargement, poor excretion of contrast medium, and air in the urinary tract. All patients had renal calculi, 34.1% of which were staghorn calculi. All patients underwent nephrectomy. For the few cases in which laparoscopy was performed, the conversion rate was high. XGP is a common histologic variant of surgically managed pyelonephritis, corresponding to almost 20% of such cases. As described in other series, we found a population that largely consisted of middle-age women. The clinical presentation was characterized mainly by pain and constitutional symptoms. The main etiologic agent isolated was Escherichia coli, and in all cases, calculi were present. Computed tomography can be considered the best imaging study to diagnose XGP, and in the few cases managed by laparoscopy, high conversion rates were observed.
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            Xanthogranulomatous pyelonephritis.

            Li Li, Anil V Parwani (2011)
            Xanthogranulomatous pyelonephritis is an uncommon chronic destructive granulomatous process of renal parenchyma in association with long-term urinary tract obstruction and infection. It affects females more often than males, with a wide range of age, from newborn to elderly. Almost all patients are symptomatic and the most common symptoms are flank or abdominal pain, lower urinary tract symptoms, fever, palpable mass, gross hematuria, and weight loss. The common laboratory findings are leukocytosis and anemia. Urine cultures most often reveal Escherichia coli and Proteus mirabilis . Computed tomography is the mainstay of diagnostic imaging for xanthogranulomatous pyelonephritis. Imaging studies may demonstrate diffuse or focal form. Histologically, xanthogranulomatous pyelonephritis presents a granulomatous inflammatory infiltrate composed of neutrophils, lymphocytes, plasma cells, xanthomatous histiocytes, and multinucleated giant cells. The differential diagnosis includes clear cell renal cell carcinoma, papillary renal cell carcinoma, sarcomatoid renal cell carcinoma, leiomyosarcoma, malakoplakia, and megalocytic interstitial nephritis. Both antibiotics and surgery can be treatment options depending on the patient's disease status.
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              Xanthogranulomatous pyelonephritis in adults: clinical and radiological findings in diffuse and focal forms.

              Jennifer D. Krause, R Loffroy, J Watfa … (2007)
              To describe the clinical and radiological features of focal and diffuse xanthogranulomatous pyelonephritis (XGP) in adults. A retrospective review of the clinical data, laboratory findings, imaging features, and surgical treatment of 13 cases of histologically proven XGP diagnosed between January 1993 and December 2005 was undertaken. There were 10 women and three men with a mean age of 55.2 years (range 30-87 years). All patients underwent both sonography and computed tomography (CT) of the kidneys. Magnetic resonance imaging (MRI) was performed in two patients. XGP was diffuse in 11 patients and focal in two patients. Fever, anorexia and weight loss, urinary symptoms, and flank pain were the most common manifestations. Urinary tract infection was found in eight patients. Sonography and CT showed diffuse kidney enlargement in seven cases and atrophy in five cases; a solitary solid mass was found in two patients. Hydronephrosis was noted in nine cases, staghorn calculus in six, and extensive pararenal disease in six. MRI failed to provide the preoperative diagnosis in the two patients with focal XGP. Total or partial nephrectomy was performed without postoperative complications. Although rare, XGP is the main differential diagnosis of malignant renal neoplasia. The definitive diagnosis depends on histological examination of the operative specimen. Preoperatively, the diagnosis can often be suspected based on imaging studies, primarily CT.
              Article 0 comments Cited 28 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                A. Artiles-Medina: alberc.artiles@gmail.com
                Journal
                Journal ID (nlm-ta): BMC Urol
                Journal ID (iso-abbrev): BMC Urol
                Title: BMC Urology
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2490
                Publication date (Electronic): 7 April 2021
                Publication date PMC-release: 7 April 2021
                Publication date Collection: 2021
                Volume: 21
                Electronic Location Identifier: 56
                Affiliations
                GRID grid.420232.5, ISNI 0000 0004 7643 3507, Department of Urology, , Hospital Universitario Ramón Y Cajal. Instituto Ramón Y Cajal de Investigación Sanitaria (IRYCIS), ; Madrid, Spain
                Article
                Publisher ID: 800
                DOI: 10.1186/s12894-021-00800-z
                PMC ID: 8026091
                PubMed ID: 33827527
                SO-VID: a1a57a8b-35f8-42e9-9855-d1c30d46b401
                Copyright © © The Author(s) 2021
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 3 November 2020
                Date accepted : 17 February 2021
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2021

                ScienceOpen disciplines: Urology
                Keywords: xanthogranulomatous pyelonephritis,antibiotic resistance,bacterial profile
                Data availability:
                ScienceOpen disciplines: Urology
                Keywords: xanthogranulomatous pyelonephritis, antibiotic resistance, bacterial profile

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