PMID- 29233628
OWN - NLM
STAT- MEDLINE
DCOM- 20190829
LR  - 20190829
IS  - 1873-4898 (Electronic)
IS  - 1477-5131 (Linking)
VI  - 14
IP  - 2
DP  - 2018 Apr
TI  - Xanthogranulomatous pyelonephritis in a paediatric cohort (1963-2016): Outcomes 
      from a large single-center series.
PG  - 169.e1-169.e7
LID - S1477-5131(17)30479-5 [pii]
LID - 10.1016/j.jpurol.2017.10.017 [doi]
AB  - BACKGROUND: Xanthogranulomatous pyelonephritis (XGP) is an uncommon chronic 
      destructive granulomatous inflammation of the kidney. It was first described in 
      1916, and is thought to affect 6/1000 cases of pyelonephritis. Its manifestations 
      are varied, and with a limited number of cases in the literature, the optimal 
      diagnosis and management of XGP in the paediatric cohort is still unknown. 
      MATERIAL AND METHODS: The medical records of children who were diagnosed and 
      treated for XGP at the current unit during the period 1963-2016, inclusive, were 
      retrospectively reviewed. Information pertaining to each patient was recorded, 
      including: demographic data, past medical history, clinical and biochemical 
      characteristics, diagnostic procedures, treatment methods, histopathologic 
      diagnosis of the removed specimen, and outcome. RESULTS: A total of 66 children 
      with a median age of 4.84 years (range 1.1-14.81), with an M:F ratio 1.35:1 
      underwent nephrectomy for XGP and had a median follow-up of 7.19 years (range 
      0.11-17.45). The most common presentations were systemic illness (62.1%), pain 
      (60.6%), urinary tract infections (54.5%) and an abdominal mass (39.4%); pyrexia 
      was present in 53%. Biochemical abnormalities included anaemia (86.3%), 
      thrombocytosis (80.3%) and hypomagnesemia (65.1%). There was an 83.3% concordance 
      between intraoperative cultures and positive mid-stream urines. Index kidneys 
      were significantly larger than the contralateral side (mean 1.32 cm; P = 0.002). 
      Staging of XGP demonstrated extension beyond the kidney in 79% of kidneys. 
      Computed tomography (CT) was performed in 11 cases (Summary figure). 
      Dimercaptosuccinic acid (DMSA) scan showed 0-10% function in 90.47% of cases. 
      Surgical procedures included nephrectomy (n = 63) and partial nephrectomy 
      (n = 3). Perioperative complications included colonic resections (n = 5) and 
      abscess formation in 18%. CONCLUSIONS: This is the largest series to date of XGP 
      in a paediatric cohort. XGP should be included in the differential diagnosis of 
      all children presenting with perirenal or psoas abscesses, renal masses and/or 
      non-functioning kidneys with/or without associated urolithiasis. Clinical 
      awareness and a high index of suspicion is required to achieve the correct 
      pre-operative diagnosis and appropriate management.
CI  - Copyright (c) 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. 
      All rights reserved.
FAU - Stoica, I
AU  - Stoica I
AD  - Department of Surgery, Division of Paediatric Urology, Our Lady's Hospital for 
      Sick Children, Crumlin, Dublin, Ireland. Electronic address: 
      stoica.ionica85@gmail.com.
FAU - O'Kelly, F
AU  - O'Kelly F
AD  - Department of Surgery, Division of Paediatric Urology, Our Lady's Hospital for 
      Sick Children, Crumlin, Dublin, Ireland.
FAU - McDermott, M B
AU  - McDermott MB
AD  - Department of Pathology, Our Lady's Hospital for Sick Children, Crumlin, Dublin, 
      Ireland.
FAU - Quinn, F M J
AU  - Quinn FMJ
AD  - Department of Surgery, Division of Paediatric Urology, Our Lady's Hospital for 
      Sick Children, Crumlin, Dublin, Ireland.
LA  - eng
PT  - Journal Article
DEP - 20171124
PL  - England
TA  - J Pediatr Urol
JT  - Journal of pediatric urology
JID - 101233150
SB  - IM
MH  - Academic Medical Centers
MH  - Adolescent
MH  - Age Factors
MH  - Biopsy, Needle
MH  - Child
MH  - Child, Preschool
MH  - Cohort Studies
MH  - Databases, Factual
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Immunohistochemistry
MH  - Ireland
MH  - Male
MH  - Nephrectomy/*methods
MH  - Pyelonephritis, Xanthogranulomatous/diagnostic imaging/*pathology/*surgery
MH  - Rare Diseases
MH  - Recurrence
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Severity of Illness Index
MH  - Sex Factors
MH  - Time Factors
MH  - Tomography, X-Ray Computed/methods
MH  - Treatment Outcome
MH  - Urinary Tract Infections/diagnosis/etiology
OTO - NOTNLM
OT  - Nephrectomy
OT  - Paediatric
OT  - Urolithiasis
OT  - Xanthogranulomatous pyelonephritis
EDAT- 2017/12/14 06:00
MHDA- 2019/08/30 06:00
CRDT- 2017/12/14 06:00
PHST- 2017/06/11 00:00 [received]
PHST- 2017/10/25 00:00 [accepted]
PHST- 2017/12/14 06:00 [pubmed]
PHST- 2019/08/30 06:00 [medline]
PHST- 2017/12/14 06:00 [entrez]
AID - S1477-5131(17)30479-5 [pii]
AID - 10.1016/j.jpurol.2017.10.017 [doi]
PST - ppublish
SO  - J Pediatr Urol. 2018 Apr;14(2):169.e1-169.e7. doi: 10.1016/j.jpurol.2017.10.017. 
      Epub 2017 Nov 24.