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Xanthogranulomatous Pyelonephritis
Lori Mankowski Gettle, MD, MBA, FSRU
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Xanthogranulomatous pyelonephritis (XGP)
          • Definitions

            • Chronic renal inflammation usually associated with longstanding urinary calculus obstruction (75%)
            • Renal parenchyma is gradually replaced by lipid-laden macrophages
              • Greek prefix "xantho-" refers to yellow color of fat
            • Diffuse (> 80%) and focal (< 20%) forms
              • Diffuse: Due to obstruction at ureteropelvic junction
              • Focal or segmental: Due to obstruction of single infundibulum or 1 moiety of duplex system
            • 3 stages of XGP: Intrarenal → perirenal → perinephric ± retroperitoneal involvement

          IMAGING

          • General Features

            • Ultrasonographic Findings

              • CT Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Microscopic Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  Selected References

                                  1. Sweet DE et al: Infiltrative renal malignancies: imaging features, prognostic implications, and mimics. Radiographics. 41(2):487-508, 2021
                                  2. Diamond M et al: Imaging of nontraumatic upper urinary tract emergencies. Semin Roentgenol. 55(2):180-196, 2020
                                  3. Karaosmanoglu AD et al: Imaging findings of infectious and inflammatory diseases of the urinary system mimicking neoplastic diseases. Abdom Radiol (NY). 45(4):1110-21, 2020
                                  4. Patiño A et al: Review of imaging findings in urinary tract infections. Semin Ultrasound CT MR. 41(1):99-105, 2020
                                  5. Vernuccio F et al: CT imaging of acute and chronic pyelonephritis: a practical guide for emergency radiologists. Emerg Radiol. 27(5):561-567, 2020
                                  6. Ifergan J et al: Imaging in upper urinary tract infections. Diagn Interv Imaging. 93(6):509-19, 2012
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Pathology

                                        • Clinical Issues

                                          TERMINOLOGY

                                          • Abbreviations

                                            • Xanthogranulomatous pyelonephritis (XGP)
                                          • Definitions

                                            • Chronic renal inflammation usually associated with longstanding urinary calculus obstruction (75%)
                                            • Renal parenchyma is gradually replaced by lipid-laden macrophages
                                              • Greek prefix "xantho-" refers to yellow color of fat
                                            • Diffuse (> 80%) and focal (< 20%) forms
                                              • Diffuse: Due to obstruction at ureteropelvic junction
                                              • Focal or segmental: Due to obstruction of single infundibulum or 1 moiety of duplex system
                                            • 3 stages of XGP: Intrarenal → perirenal → perinephric ± retroperitoneal involvement

                                          IMAGING

                                          • General Features

                                            • Ultrasonographic Findings

                                              • CT Findings

                                                • Imaging Recommendations

                                                  DIFFERENTIAL DIAGNOSIS

                                                    PATHOLOGY

                                                    • General Features

                                                      • Microscopic Features

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Demographics

                                                            • Natural History & Prognosis

                                                              • Treatment

                                                                DIAGNOSTIC CHECKLIST

                                                                • Consider

                                                                  Selected References

                                                                  1. Sweet DE et al: Infiltrative renal malignancies: imaging features, prognostic implications, and mimics. Radiographics. 41(2):487-508, 2021
                                                                  2. Diamond M et al: Imaging of nontraumatic upper urinary tract emergencies. Semin Roentgenol. 55(2):180-196, 2020
                                                                  3. Karaosmanoglu AD et al: Imaging findings of infectious and inflammatory diseases of the urinary system mimicking neoplastic diseases. Abdom Radiol (NY). 45(4):1110-21, 2020
                                                                  4. Patiño A et al: Review of imaging findings in urinary tract infections. Semin Ultrasound CT MR. 41(1):99-105, 2020
                                                                  5. Vernuccio F et al: CT imaging of acute and chronic pyelonephritis: a practical guide for emergency radiologists. Emerg Radiol. 27(5):561-567, 2020
                                                                  6. Ifergan J et al: Imaging in upper urinary tract infections. Diagn Interv Imaging. 93(6):509-19, 2012