Xanthogranulomatous Pyelonephritis: A Complicated Febrile Urinary Tract Infection Detected by Point-of-Care Ultrasound in the Emergency Department

Gibbons, Ryan C.; Leonard, Nicole; Magee, Mark; Zanaboni, Allison; Patterson, Jessica; Costantino, Thomas

doi:10.1016/j.jemermed.2018.04.016

Cited by 5 publications

(8 citation statements)

References 14 publications

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“…The weighted pooled mortality was 1436 deaths per 100 000 patients. As hypothesized, this is much lower than the previously stated figures of <40% [6,7]. These lower mortality rates may be related to multifactorial improvements in care, including broader antibiotic options, wider availability of CT scanning allowing earlier diagnosis, and superior intensive care cardiorespiratory capabilities.…”

Section: Discussionmentioning

confidence: 71%

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Xanthogranulomatous pyelonephritis: a systematic review of treatment and mortality in more than 1000 cases

et al. 2022

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To systematically review the current demographics, treatment and mortality rate associated with xanthogranulomatous pyelonephritis (XGP) and to test the hypothesis that the weighted pooled peri-operative mortality rate will be <10%. MethodsSearches were performed of the Cochrane, Embase and Medline databases and the grey literature for studies published during the period 1 January 2000 to 30 August 2021. Eligible studies reported cohorts of ≥10 predominantly adult patients with XGP and described either average patient age or mortality rate. ResultsIn total, 40 eligible studies were identified, representing 1139 patients with XGP. There were 18 deaths, with a weighted pooled peri-operative mortality rate of 1436 per 100 000 patients. The mean age was 49 years, 70% of patients were female and 28% had diabetes mellitus. The left kidney was more commonly affected (60%). Four patients had bilateral XGP, and all of whom survived. Renal or ureteric stones were present in 69% of patients, including 48% with staghorn calculi. Urine culture was positive in 59% of cases. Fistulae were present in 8%. Correct preoperative diagnosis occurred in only 45% of patients. Standard treatment continues to comprise a short cause of antibiotics and open radical (total) nephrectomy. Preoperative decompression occurred in 56% of patients. When considered at all, laparoscopic nephrectomy was performed in 34% of patients. Partial nephrectomy was conducted in 2% of patients. ConclusionsXanthogranulomatous pyelonephritis has a lower mortality rate than historically reported. A typical patient is a woman in her fifth or sixth decade of life with urolithiasis. While open radical nephrectomy remains the most common treatment method, laparoscopic, and to a lesser degree partial nephrectomy, are feasible in well selected patients.

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Section: Discussionmentioning

confidence: 71%

“…Xanthogranulomatous pyelonephritis is considered life‐threatening and peri‐operative mortality has been reported to be as high as 40% [6,7]. However, the modern mortality rate is unknown.…”

Section: Introductionmentioning

confidence: 99%

Xanthogranulomatous pyelonephritis: a systematic review of treatment and mortality in more than 1000 cases

et al. 2022

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“…There are multiple case reports of other diseases identified on renal POCUS including renal trauma, 5 renal cell carcinoma, 6 urinomas, 7 emphysematous pyelonephritis, 8 pyonephrosis, 9 and xanthrogranulomatous pyelonephritis. 10 Furthermore, its routine use in some other conditions has been advocated. Chen et al conducted a retrospective review of patients diagnosed with acute pyelonephritis (APN) and found that emergency renal ultrasonography identified pathology in 60.9% of complicated APN.…”

Section: Discussionmentioning

confidence: 99%

Renal Vein Thrombosis on Point-of-care Ultrasound in the Emergency Department: A Case Report

Haimowitz

Gonzalez

2022

Clinical Practice and Cases in Emergency Medicine

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Introduction: This case report of renal vein thrombosis found on emergency bedside ultrasound illustrates the expanding role of point-of-care ultrasound (POCUS) in rapidly identifying rare renal pathologies. Case Report: A 16-year-old female with a complex medical history presenting with right-sided abdominal pain and tenderness was found to have significant renal POCUS findings consistent with renal vein thrombosis. Conclusion: In the medically complex patient with nonspecific chief complaints, it can be challenging to rapidly narrow a broad differential diagnosis. Point-of-care ultrasound has proven to be an extremely useful tool for this purpose. As emergency physicians become more proficient in the use of ultrasonography, it is likely that POCUS will be used with increasing frequency to identify additional pathology outside its traditional applications.

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“…Chronic complicated infections require prompt decompression; 12% of cases of presumed to be simple pyelonephritis require emergent urologic intervention [8]. Conservative management with antibiotics fails to treat the underlying process [9].…”

Section: Treatmentmentioning

confidence: 99%

“…XGP usually affects one kidney but a few (sixteen) case reports have described patients with bilateral XGP, making a therapeutic challenge [7]; the decision between conservative, partial or complete nephrectomy and antibiotic therapy is based on case individualization by the clinicians. Finally, it is an insidious disease that can lead to end-stage renal disease and its mortality rate exceeds 40% [8]. We present the case of a patient with bilateral XGP in whom a rare etiologic agent was isolated from renal tissue culture through matrixassisted laser desorption ionization-time of flight (MALDI-TOF).…”

Section: Introductionmentioning

confidence: 99%

Bilateral Xanthogranulomatous Pyelonephritis due to Staphylococcus Schleiferi: An Uncommon Presentation

Aguilar-Rivera¹,

Jiménez-Castillo²,

Zamora-López³

et al. 2021

Arch Nephrol Urol

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Xanthogranulomatous pyelonephritis (XGP) describes a rare infectious disease with a destructive granulomatous process. The literature contains few cases of bilateral XGP and no cases due to Staphylococcus schleiferi; we diagnosed it with the advance at imaging and bacterial identification systems technology. This is a case of a 22-year-old female at our emergency department complaining of abdominal pain, nausea, emesis, dyspnea of 3 weeks. Medical history included Chronic Kidney Disease (CKD) treated with Peritoneal dialysis and history of recurrent urinary tract infection. On examination, we found signs of septic shock and suprapubic tenderness. No flank or renal mass found on examination. Tomography (CT) scan showed bilateral kidney enlargement with pyelocaliceal dilatation due to stones obstructing ureteral union; presence of gas on left kidney´s renal pelvis and an abscess in the posterior pararenal space. We diagnosed Bilateral XGP and emphysematous pyelitis, initiated boardspectrum antibiotic and perform urgent right nephrostomy and left nephrectomy. The urinary, blood and renal tissue culture identified pathogenic agents (Escherichia coli and Staphylococcus schleiferi) and antibiotic treatment was de-escalated. After two weeks of treatment, she recovered of an acute on chronic renal failure (ACRF) remaining with 24ml/min/1.73m 2 of GFR (stage IV of CKD) and was discharged from hospital.

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Xanthogranulomatous Pyelonephritis: A Complicated Febrile Urinary Tract Infection Detected by Point-of-Care Ultrasound in the Emergency Department

Cited by 5 publications

References 14 publications

Xanthogranulomatous pyelonephritis: a systematic review of treatment and mortality in more than 1000 cases

Xanthogranulomatous pyelonephritis: a systematic review of treatment and mortality in more than 1000 cases

Renal Vein Thrombosis on Point-of-care Ultrasound in the Emergency Department: A Case Report

Bilateral Xanthogranulomatous Pyelonephritis due to Staphylococcus Schleiferi: An Uncommon Presentation

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