Xanthogranulomatous Pyelonephritis: Clinical Diagnosis and Surgical Management

Xanthogranulomatous pyelonephritis (XGP) is an uncommon, severe form of chronic renal inflammation characterised by destruction of the renal parenchyma and replacement with lipid‐laden macrophages, granulomatous tissue and fibrosis. Clinically, it often presents with non‐specific symptoms such as flank pain, fever and malaise, frequently in association with urinary tract obstruction by large calculi. Imaging—most commonly computed tomography—reveals characteristic features including renal enlargement, calyceal dilatation, staghorn calculi and perinephric collections or fistulae to adjacent structures. Definitive diagnosis rests on histopathological examination, but preoperative recognition guides management. Therapeutic strategies combine targeted antibiotic therapy with surgical removal of the affected kidney or lesion, ranging from nephron‐sparing approaches in focal disease to radical nephrectomy in diffuse or complicated presentations. Minimally invasive techniques have matured to address the intense perirenal adhesions and inflammatory changes that typify advanced XGP, and multidisciplinary collaboration is essential to optimise outcomes across diverse healthcare settings.

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Xanthogranulomatous Pyelonephritis: Clinical Diagnosis and Surgical Management publication trend

The graph below shows the total number of articles in xanthogranulomatous pyelonephritis: clinical diagnosis and surgical management across all publications each year (not limited to Nature Index journals).

Technical terms

Xanthogranulomatous pyelonephritis (XGP): A chronic inflammatory renal condition marked by destruction of kidney tissue and accumulation of lipid‐laden macrophages and granulomas.

Staghorn calculus: A large, branching kidney stone that occupies the renal pelvis and calyces, often causing obstruction and infection.

Nephrectomy: Surgical removal of an entire kidney (radical) or part of a kidney (partial) to treat disease or preserve renal function.

Gerota’s fascia: The fibrous envelope surrounding the kidney and adrenal gland, which is a surgical landmark in renal dissection.

Computed tomography (CT): A cross‐sectional imaging modality using X-rays to visualise internal structures, essential for diagnosing and staging XGP.

References

1. MDCT Diagnosis and Staging of Xanthogranulomatous Pyelonephritis. Diagnostics (2023).
2. Laparoscopic nephrectomy outside gerota fascia and en bloc ligation of the renal hilum for management of inflammatory renal diseases. International braz j urol (2018).
3. Xanthogranulomatous pyelonephritis: a focus on microbiological and antibiotic resistance profiles. BMC Urology (2021).
4. Computed Tomography Findings in Xanthogranulomatous Pyelonephritis. Journal of Clinical Imaging Science (2011).