XANTHOGRANULOMATOUS PYELONEPHRITIS IN CHILDHOOD - PREOPERATIVE DIAGNOSIS IS POSSIBLE

Objective To diagnose xanthogranulomatous pyelonephritis (XGP) in chil dhood pre-operatively. Patients and methods Eleven cases of XGP presen ting to Birmingham Children's Hospital over a 10-year-period are repor ted. Nine (82%) were diagnosed preoperatively on the clinical and radi ological findings. Results The characteristic clinical findings were u rinary tract infection (9 cases), palpable renal mass (8 cases) and an aemia (8 cases). The most common radiological findings were enlarged k idney (9 cases), renal calculi (7 cases) and non-functioning kidney (6 cases). Renal ultrasound typically demonstrated a central echoic area (6 cases) and multiple hypoechoic areas in the parenchyma (7 cases). A computed tomography (CT) scan was performed in three cases. This sho wed characteristic multiple, low attenuation, unenhanced areas within the parenchyma with extension of the inflammatory process into peri-ne phric fat (two cases). Ten cases (91%) were of the diffuse type. There was extension into the peri-nephric fat in eight cases (73%). Three c ases (27%) were associated with congenital urological abnormalities. N ephrectomy was performed in 10 cases and a partial nephrectomy in one. Conclusion XGP is uncommon in childhood but should always be consider ed in the differential diagnosis of renal masses, especially in the pr esence of anaemia. Nephrectomy usually results in a permanent cure.