SHM Converge Scientific Abstract ePoster Gallery-A Kidney Lost: A Presentation of Xanthogranulomatous Pyelonephritis and Subsequent Nephrectomy

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This case report describes an 18-year-old male with quadriplegia, tracheostomy/vent dependence, and recurrent UTIs who presented with 2–3 weeks of fever, chills, malaise, abdominal pain, nausea, vomiting, diarrhea, and poor appetite. Initial labs showed leukocytosis, thrombocytosis, and mild anemia. Urinalysis and culture supported infection, growing E. coli and Klebsiella.<br /><br />Imaging revealed a large obstructing left ureteral stone, renal enlargement, hydronephrosis, and multiple areas of nonenhancement within the kidney, findings concerning for xanthogranulomatous pyelonephritis (XGP). A percutaneous nephrostomy tube was placed, but the kidney was nonviable due to extensive disease, so nephrectomy was required to reduce infection risk.<br /><br />The discussion explains that XGP is a rare, destructive form of chronic pyelonephritis caused most often by chronic urinary obstruction, usually from stones, and can lead to a nonfunctional kidney. It is much more common in adults, especially middle-aged women, and is extremely rare in children and adolescents. Typical organisms include Proteus, Pseudomonas, Enterococcus, E. coli, and Klebsiella.<br /><br />This patient likely developed severe disease because of multiple risk factors: recurrent UTIs, loss to follow-up, chronic urinary obstruction, and inability to report typical symptoms such as flank pain or dysuria due to quadriplegia. The authors emphasize that XGP should be considered in patients with fever, hematuria, abdominal mass, flank pain, or recurrent UTIs, particularly when symptoms may be atypical or masked in medically complex patients.

Asset Subtitle

Dominique S. Jones

Meta Tag

Author List Dominique S. Jones, Michael Maguire

Category Clinical Vignettes

Concept Xanthogranulomatous Pyelonephritis

Concept Renal Obstruction

Concept Infection

Concept Nephrolithiasis

Concept Urinary Tract Infection

Distinguished Non-Finalist

Presenter Organization TJU Sidney Kimmel Medical College/Nemours Children’s Hospital, Delaware

Presenting Author Dominique S. Jones

Track Pediatric

Keywords

xanthogranulomatous pyelonephritis

quadriplegia

recurrent urinary tract infections

ureteral stone

hydronephrosis

nephrectomy

percutaneous nephrostomy

E. coli

Klebsiella

chronic urinary obstruction

Xanthogranulomatous Pyelonephritis

Renal Obstruction

Infection

Nephrolithiasis

Urinary Tract Infection