This clinical report
presents a 45-year-old female patient with acute kidney injury, hepatic
dysfunction and urosepsis without past history of any illness related to
urinary system. Laboratory investigations showed Hb 15.6 gm/dl, neutrophilic
leukocytosis, thrombocytes 9000/mm3, ESR 90 mm/h, plasma
thromboplastin time (PTT) 48 seconds (control 32 seconds), INR 2, and fibrinogen
degradation product 7500 ng/ml (normal <250 ng/ml). Serum creatinine was 450
μmol/L (5.1 mg/dl), direct bilirubin 68.40 μmol/L, alanine aminotransferase 1.6
mmol/L and albumin 25 gm/L. Urinalysis revealed leucocyturia, hematuria without
casts and proteinuria. Abdominal plain x-ray revealed left-sided radio-opaque shadow at
the ureteric line, left uretero-hydronephrosis with thickened cortex and left ureteric
stone, but normal right kidney. Computerized tomography of abdomen showed a
large left kidney (13.5 cm) with totally distorted architecture, multiple
enhancing and non-enhancing
sectors, thickening of renal capsule, moderate dilatation of renal pelvis,
dilated ureter and no passage of contrast in the ureter. The patient was
treated with a 2-week course of Ceftriaxone and Aztreonam and preoperative
session of hemodialysis before the performance of a left-sided nephrectomy.
Gross examination revealed adherent capsule, granular cortex covered with
purulent exudates, no demarcation between cortico-medullary junction, and the
cut surface showed minute abscess and necrosis with markedly dilated pelvis.
Light microscopic examination showed fibrosis and inflammation of parenchyma
with vacuolized histiocytes foam cells surrounding necrotic areas confirming
the diagnosis of xanthogranulomatous pyelonephritis. The patient was discharged
after 35 days of hospital stay with normal renal and hepatic function.
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