XANTHOCRANULOMATOUS PYELONEPHRITIS, THE GATEKEEPERS DILEMMA - A CONTEMPORARY LOOK AT AN OLD PROBLEM

Objectives, To review 12 patients with a clinicopathogenic diagnosis o f xanthogranulomatous pyelonephritis (XGP) and to determine if a compu ted tomography (CT) scan is the imaging procedure of choice for diagno sis. Methods. A retrospective review, over the last 12 years, of patie nts with XGP at our institution. Results. Nine of 10 patients (90%) wh o were evaluated by CT scan had the correct diagnosis made prior to ne phrectomy, The most common presenting symptoms and signs were flank pa in (64%), leukocytosis (73%), and anemia (82%). Seventy-five percent o f the patients had a ureteropelvic junction stone or a staghorn stone in the affected kidney at the time of clinical presentation. Proteus w as the most common organism cultured. Conclusions. After reviewing the clinical features of these 12 patients, we recommended CT scan to eva luate the patient in whom clinical suspicion of XGP is entertained. CT has proven to be the most accurate imaging study to evaluate this dis ease.