The role of laparoscopic nephrectomy in pediatric xanthogranulomatous pyelonephritis: a case report

Abstract

Xanthogranulomatous pyelonephritis (XGP) is a rare chronic renal infection characterized by the destruction of renal parenchyma. Traditional treatment involves open radical nephrectomy, which is challenging due to the inflammatory process associated with XGP. More recently, laparoscopic nephrectomy has been employed successfully in adult XGP. We present a case of a six-year-old female child with XGP who was successfully treated by laparoscopic nephrectomy with minor complications. Our case demonstrates the safety and feasibility of laparoscopic nephrectomy for childhood XGP, indicating that it should be considered a management option in such cases.

Figure 1

Predrainage CT with contrast demonstrates calcified debris filling the pelvis and proximal ureter. There is destruction of the lower pole renal parenchyma (not pictured) which is contiguous with a 7 × 6 × 5 cm abscess and destruction of the upper pole renal parenchyma with a 4 × 3 × 2 cm abscess.

Figure 2

A retrograde pyelogram prior to surgery shows opacification of the dilated left renal collecting system with abundant internal debris noted within the renal pelvis and proximal ureter. The ureteropelvic junction appears narrowed, though obstruction elsewhere along the ureter and dilating reflux cannot be ruled out.

Figure 3

Numerous foamy histiocytes forming granulomas with occasional plasma cells and lymphocytes (1000x image).