Late consequence of nephrolithiasis – xanthogranulomatous pyelonephritis with fistula formation
Szikszai Adél dr., Fehér Gabriella dr., Gécs Sándor dr. Csolnoky Ferenc Kórház, Urológiai osztály, Veszprém (osztályvezető: Gécs Sándor dr.)
Objective: Xanthogranulomatous pyelonephritis is a rare disease. This is a special chronic inflammatory disorder with cholesterol and lipid cell deposits in the kidney. It is 4 times more common in women than in men and is usually noted in the fifth and sixth decades of life. It is most commonly associated with E. coli or Proteus mirabilis infection and urinary tract obstruction.
Case report: There are ESWL therapy and PCNL surgery due to nephrolithiasis in the medical history of our 66-year-old female patient. After these interventions she hasn’t been examined at urology for years. She has been examined at emergency unit in October 2015 with right side pain from kidney area and subfebrile temperature. At the examination at surgery ambulance an abscess size of a chicken egg was incised on her right costovertebral region and at the place of the incision a 5-6 cm long fistula was found by probe. During our urology examination we found a hydronephrotic dilated right kidney and an approximately 2 cm sized stone in the pyelon. We asked for a CT scan to clarify the right kidney’s status. This described a 22×15×25 mm stone at the right side of the pyelouretal junction, significant thinning of the renal parenchyma joining with huge dilation of the renal cavity system. In the pyelon and the middle-lower calyces’ ends an air-liquid level was also observed. During the examination there was no significant contrast agent excretion in the pyelon. Thus we decided for right side nephrectomy which was performed in antibiotic protection after the proper preparation of the patient. Histology described xanthogranulomatous inflammation. In the postoperative period the wound healing was undisturbed. The patient was discharged home in good physical status at the 9th day of the postoperative period.
Conclusion: In case of an inflammation with fistula formation, nephrolithiasis and invasion to the surrounding tissues surgery is necessary as early as possible. In this case radical nephrectomy was needed. We wanted to draw your attention to our patient diagnosed with the rare xanthogranulomatous pyelonephritis, highlighting the importance of looking after the patients with nephrolithiasis.
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