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Xanthogranulomatous Pyelonephritis
Lori Mankowski Gettle, MD, MBA, FSRU; Alessandro Furlan, MD; R. Brooke Jeffrey, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              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

              IMAGING

              • General Features

                • Fluoroscopic Findings

                  • Ultrasonographic Findings

                    • CT Findings

                      • MR Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Staging, Grading, & Classification

                                • Gross Pathologic & Surgical Features

                                  • Microscopic Features

                                    CLINICAL ISSUES

                                    • Presentation

                                      • Demographics

                                        • Natural History & Prognosis

                                          • Treatment

                                            DIAGNOSTIC CHECKLIST

                                            • Consider

                                              • Image Interpretation Pearls

                                                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):180-96, 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):561-7, 2020
                                                6. Conti VS et al: Xanthogranulomatous pyelonephritis: the case of a perplexing kidney. BMJ Case Rep. 2014, 2014
                                                7. Craig WD et al: Pyelonephritis: radiologic-pathologic review. Radiographics. 28(1):255-77; quiz 327-8, 2008
                                                8. Bhatt S et al: Renal pseudotumors. AJR Am J Roentgenol. 188(5):1380-7, 2007
                                                9. Kim J: Ultrasonographic features of focal xanthogranulomatous pyelonephritis. J Ultrasound Med. 23(3):409-16, 2004
                                                10. Iannacone R et al: Bilateral xanthogranulomatous pyelonephritis (XGP) with perirenal extension: MRI findings. Published March 1, 2004. Accessed May 11, 2014. http://www.eurorad.org/case.php?id=2802
                                                11. Cakmakci H et al: Pediatric focal xanthogranulomatous pyelonephritis: dynamic contrast-enhanced MRI findings. Clin Imaging. 26(3):183-6, 2002
                                                12. Tiu CM et al: Sonographic features of xanthogranulomatous pyelonephritis. J Clin Ultrasound. 29(5):279-85, 2001
                                                13. Pickhardt PJ et al: From the archives of the AFIP. Infiltrative renal lesions: radiologic-pathologic correlation. Armed Forces Institute of Pathology. Radiographics. 20(1):215-43, 2000
                                                14. Verswijvel G et al: Xanthogranulomatous pyelonephritis: MRI findings in the diffuse and the focal type. Eur Radiol. 10(4):586-9, 2000
                                                15. Hayes WS et al: From the archives of the AFIP. Xanthogranulomatous pyelonephritis. Radiographics. 11(3):485-98, 1991
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Terminology

                                                  • Imaging

                                                    • Top Differential Diagnoses

                                                      • Pathology

                                                        • Clinical Issues

                                                          • Diagnostic Checklist

                                                            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

                                                            IMAGING

                                                            • General Features

                                                              • Fluoroscopic Findings

                                                                • Ultrasonographic Findings

                                                                  • CT Findings

                                                                    • MR Findings

                                                                      • Imaging Recommendations

                                                                        DIFFERENTIAL DIAGNOSIS

                                                                          PATHOLOGY

                                                                          • General Features

                                                                            • Staging, Grading, & Classification

                                                                              • Gross Pathologic & Surgical Features

                                                                                • Microscopic Features

                                                                                  CLINICAL ISSUES

                                                                                  • Presentation

                                                                                    • Demographics

                                                                                      • Natural History & Prognosis

                                                                                        • Treatment

                                                                                          DIAGNOSTIC CHECKLIST

                                                                                          • Consider

                                                                                            • Image Interpretation Pearls

                                                                                              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):180-96, 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):561-7, 2020
                                                                                              6. Conti VS et al: Xanthogranulomatous pyelonephritis: the case of a perplexing kidney. BMJ Case Rep. 2014, 2014
                                                                                              7. Craig WD et al: Pyelonephritis: radiologic-pathologic review. Radiographics. 28(1):255-77; quiz 327-8, 2008
                                                                                              8. Bhatt S et al: Renal pseudotumors. AJR Am J Roentgenol. 188(5):1380-7, 2007
                                                                                              9. Kim J: Ultrasonographic features of focal xanthogranulomatous pyelonephritis. J Ultrasound Med. 23(3):409-16, 2004
                                                                                              10. Iannacone R et al: Bilateral xanthogranulomatous pyelonephritis (XGP) with perirenal extension: MRI findings. Published March 1, 2004. Accessed May 11, 2014. http://www.eurorad.org/case.php?id=2802
                                                                                              11. Cakmakci H et al: Pediatric focal xanthogranulomatous pyelonephritis: dynamic contrast-enhanced MRI findings. Clin Imaging. 26(3):183-6, 2002
                                                                                              12. Tiu CM et al: Sonographic features of xanthogranulomatous pyelonephritis. J Clin Ultrasound. 29(5):279-85, 2001
                                                                                              13. Pickhardt PJ et al: From the archives of the AFIP. Infiltrative renal lesions: radiologic-pathologic correlation. Armed Forces Institute of Pathology. Radiographics. 20(1):215-43, 2000
                                                                                              14. Verswijvel G et al: Xanthogranulomatous pyelonephritis: MRI findings in the diffuse and the focal type. Eur Radiol. 10(4):586-9, 2000
                                                                                              15. Hayes WS et al: From the archives of the AFIP. Xanthogranulomatous pyelonephritis. Radiographics. 11(3):485-98, 1991