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Xanthogranulomatous Pyelonephritis Clinical Presentation

  • Author: Samuel G Deem, DO; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
Updated: Nov 09, 2014

History and Physical Examination

Patients with xanthogranulomatous pyelonephritis (XGP) often appear chronically ill. Symptoms include anorexia, fever, chills, weight loss, and flank pain. The pain of XGP is not colicky in nature; it is usually dull and persistent.[6]

XGP is notorious for fistulization. Pyelocutaneous and ureterocutaneous fistulae have been well described. Other organs are occasionally involved in this process, including surrounding viscera (with resulting pyeloenteric fistulae).

Obstruction associated with XGP in the pediatric population is more likely to be due to congenital factors than to obstructive calculi.

As an illustration of the varied presentation of XGP, a case report by Hitti et al describes XGP located in a renal allograft.[7] Another report describes a case of XGP associated with psoas abscess in a young pregnant woman in her third trimester.[8]

Contributor Information and Disclosures

Samuel G Deem, DO Faculty, Department of Urology, Charleston Area Medical Center

Samuel G Deem, DO is a member of the following medical societies: American College of Surgeons, American Osteopathic Association, American Urological Association, Endourological Society, Society of Urologic Oncology, American Society of Clinical Oncology, American College of Osteopathic Surgeons

Disclosure: Nothing to disclose.


Joe D Mobley, III, MD, MPH Urologist, Kentucky Lake Urology Clinic

Joe D Mobley, III, MD, MPH is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Endourological Society, Tennessee Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, Society of Laparoendoscopic Surgeons, Society of University Urologists, Association of Military Osteopathic Physicians and Surgeons, American Urological Association, Endourological Society

Disclosure: Nothing to disclose.


Gamal Mostafa Ghoniem, MD, FACS Professor of Urology, Chief, Division of Female Urology, Pelvic Reconstructive Surgery, and Voiding Dysfunction, Department of Urology, University of California, Irvine, School of Medicine

Gamal Mostafa Ghoniem, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urogynecologic Society, American Urological Association, International Continence Society, International Urogynaecology Association, and Society of Urodynamics and Female Urology

Disclosure: Astellas Honoraria Speaking and teaching; Coloplasty Consulting fee Board membership; Uroplasty Consulting fee Consulting

Scott Rutchik, MD Assistant Professor, Department of Surgery, Division of Urology, University of Connecticut School of Medicine

Scott Rutchik, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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Xanthogranulomatous pyelonephritis.
Xanthogranulomatous pyelonephritis with obstruction and staghorn calculus.
Xanthogranulomatous pyelonephritis appearing as nonenhancing, low-attenuation areas of the dilated collecting system surrounded by enhancing, high-attenuation parenchyma (known as the "bear paw" sign).
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