Laparoskopowe leczenie żóltakowego zapalenia nerki – opis przypadku

Abstract

Author(s): Dominik Godlewski, Szczepan Pabiś,Jacek Tereszkiewicz, Maria Mazurkiewicz

Xanthogranulomatous pyelonephritis is a rare disease, usually caused by nephrolithiasis or an obstruction of the urine outflow from the kidney. The disease is suspected on the basis of a tetrad of symptoms: a renal tumour found in an imaging examination, a chronic infection of the urinary tract (a positive urine culture), an impaired function of the affected kidney, and - frequently - nephrolithiasis. However, the clinical picture may sometimes be non-specific, with body weight loss, subfebrile condition, and a tumour revealed in imaging examinations, which may suggest a neoplastic process. That is why in literature XGP is called „a grat imitator”. The treatment of choice is surgery involving nephrectomy and a resection of the tissues affected by the inflammatory condition. We present a case of a 72-year-old patient who was diagnosed due to a weight loss in the preceding three months and general weakness. The diagnostic examination revealed a tumour in the left kidney. The patient was qualified for a radical laparoscopic resection of the left kidney. In the course of the surgery, increased difficulty was encountered in preparing the perirenal tissues and the area of renal hilus due to an intensified inflammatory reaction. In the intra- and postoperative course no complications were observed. After four weeks the patient regained his full physical pre-surgery ability. On the basis of a histopathological examination the following was diagnosed: Pyelonephritis xantogranulomatosa. Calcinosis renis focalis. Pelvis renis sine lesionibus. XGP is a disease that damages renal parenchyma and leads to complications as a consequence of a spreading inflammatory process. The treatment of choice is surgical nephrectomy with a resection of the tissues affected by the inflammatory condition. In cases where the extent of the lesion is limited by Gerota’s fascia, laparoscopic access is reasonable. One of the first reports is the study by Bercowski et al. from 1999, comparing two groups of patients with XGP operated with the open method and with the laparoscopic method, with complications being reported solely in the latter group. It is symptomatic, however, that the recovery time of the patients after an endoscopic operation was only half as long as in the other group. In later publications the rate of complications is comparable for both methods, while the laparoscopic method involves a lower intraoperative blood loss, an earlier return to oral alimentation and, first of all, a significantly shorter time of regaining full pre-surgery activity. Guzzo et al compared the complications after both methods and concluded that it is not the method but the advancement stage of the disease that is decisive for the number of complications. Therefore, in carefully selected cases and with the surgeon’s adequate experience, laparoscopic nephrectomy may be applied in the treatment of XGP without exposing the patients to an increased risk of complications.

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