Presentation
Intermittent back pain in the community without flank pain or abdominal pain.
Patient Data
Large right renal pelvis staghorn calculus and bear paw sign due to dilated renal calyces, along with ipsilateral perinephric fluid and fat stranding, suggest xanthogranulomatous pyelonephritis.
No organized collection.
Case Discussion
The patient was a middle-aged female who initially presented to a community doctor for assessment of intermittent back pain (paraspinal) without flank pain, fever, hematuria, malaise, weight loss or other associated symptoms. The patient had no past medical history (was not diabetic) and denied recurrent lower urinary tract symptoms.
CT imaging was ordered in the community to characterize atypical lower back pain, and incidental large renal calculus was identified, which was subsequently imaged as above.
Patient was found to be hypokalemic on blood pathology without acute change in renal function. Urine culture was positive (gram-negative multi-sensitive organism).
Patient underwent right nephrostomy while awaiting surgical management with nephrectomy.
Xanthogranulomatous pyelonephritis is a rare form of chronic pyelonephritis, known to most frequently occur in middle-aged female patients. Interventional techniques such as nephrostomy play a role in management, with many undergoing pre-operative renal drainage, though this rarely leads to renal salvage. Definitive surgical management with nephrectomy is the mainstay of treatment, however open nephrectomy is required in the majority of cases with relatively high post-operative complication rates.
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