Complicated pyelonephritis associated with chronic renal stone disease
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ABDOMINAL RADIOLOGY
Complicated pyelonephritis associated with chronic renal stone disease Federica Ciccarese1 · Nicolò Brandi1 · Beniamino Corcioni1 · Rita Golfieri1 · Caterina Gaudiano1 Received: 2 July 2020 / Accepted: 16 November 2020 © The Author(s) 2020
Abstract Purpose This article reviews imaging manifestations of complicated pyelonephritis associated with chronic renal stones disease, in particular xanthogranulomatous pyelonephritis (XGP) and emphysematous pyelonephritis (EPN), as potential mimics of other renal diseases and malignances and provides helpful tips and differentiating features that may alert the radiologist to suspect a diagnosis of infection. Materials and methods A retrospective review of the records from 6 adult patients (5 females and 1 male, mean age 72,3 years) with diagnosis of XGP associated with chronic nephrolithiasis and 7 adult patients (6 females and 1 male, mean age 59,3 years) with diagnosis of EPN associated with chronic nephrolithiasis from January 2010 to January 2020 was carried out. Computed tomography urography (CTU) with at least an unenhanced scan, and the parenchymal and excretory phases after contrast medium administration performed at our Teaching Hospital were included. When available images related to conventional radiography, ultrasound (US) and magnetic resonance imaging of the same patients, the comparison with CTU images was carried out. Conclusion A possible diagnosis of XGP or EPN must always be taken into account when a pyelonephritis is associated with untreated kidney stones, especially whenever clinical presentation is atypical, current therapy is not effective and imaging shows features of dubious interpretation. Due to their rarity and atypical presentation, a multidisciplinary approach is required and an expert radiologist represents a key figure in the multidisciplinary team as he can help to differentiate between benign and malignant lesions and thus avoid unnecessary radical surgical procedures. Keywords Xanthogranulomatous pyelonephritis · Emphysematous pyelonephritis · Complicated pyelonephritis · Renal stone disease · Nephrolithiasis
Introduction Renal stone disease is very common, affecting 5–20% of worldwide population, and its prevalence is increasing in industrialized countries, due to dietary factors and even global warming [1]. Nephrolithiasis is now recognized as both chronic and systemic conditions [2], further underscoring the great impact of the disease and the consequent economic burden on the healthcare system [3]. In fact, several studies have proved that stone formers’ morbidity and mortality rates are higher compared to control subjects,
* Nicolò Brandi [email protected] 1
Department of Radiology, IRCCS Azienda OspedalieroUniversitaria di Bologna, Via Albertoni 15, Bologna, Italy
independently from comorbidities associated such as diabetes, heart failure and hypertension. Chronic renal stone disease is a major risk factor for urinary tract infection and, when the latter overlaps, pyelonephritis may occur,
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