Quiz page answers september 2003   American Journal of Kidney Diseases  Volume 42, Issue 3, Pages A42-A44 (September 2003) DOI: 10.1016/S0272-6386(03)00811-4 Copyright © 2003 Terms and Conditions

Figure 20A The abdominal ultrasound. What do you see on this transverse scan of the right kidney? What would be your next step? The kidney is enlarged and there are signs of concretions (black arrow), pyonephrosis, and gas formation. A contrast-enhanced computed tomography (CT) scan of the abdomen was made. American Journal of Kidney Diseases 2003 42, A42-A44DOI: (10.1016/S0272-6386(03)00811-4) Copyright © 2003 Terms and Conditions

Figure 20B What do you see on this enhanced CT scan? What is your diagnosis and what would be your next step? The kidney is enlarged; there are multiple concretions (black arrow), signs of gas formation (white arrow), and hypoattenuating masses representing abscesses. There is also infiltration of the psoas muscle and perirenal area. Our diagnosis is xanthogranulomatous pyelonephritis. The CT scan is the best way to preoperatively diagnose this disease. Treatment of choice is nephrectomy. American Journal of Kidney Diseases 2003 42, A42-A44DOI: (10.1016/S0272-6386(03)00811-4) Copyright © 2003 Terms and Conditions

Figure 20C Pathological examination, which confirmed our diagnosis. The liver dysfunction disappeared in a few months. Xanthogranulomatous pyelonephritis is a form of chronic pyelonephritis, which is frequently accompanied by liver dysfunction. This dysfunction is most likely caused by cytokines, like tumor necrosis factor-α, interleukin-1β, and interleukin-6, which are released during the ongoing chronic pyelonephritis. The hepatic dysfunction is similar to the Stauffer's syndrome in hypernephroma. Usually hepatomegaly; elevated alanine aminotransferase and γ-glutamyltransferase, α-globulins, and erythrocyte sedimentation rate; thrombocytosis; and prolongation of the prothrombin time are seen. To our knowledge, jaundice caused by intrahepatic cholestasis as the presenting sign of xanthogranulomatous pyelonephritis has not been previously reported. Final diagnosis: Xanthogranulomatous pyelonephritis. American Journal of Kidney Diseases 2003 42, A42-A44DOI: (10.1016/S0272-6386(03)00811-4) Copyright © 2003 Terms and Conditions