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FIGURE 7-40 (see Color Plate)

Xanthogranulomatous pyelonephritis (XPN). XPN is a special form of chronic renal inflammation caused by an abnormal immune response to infected obstruction [13]. This case in a middle-aged woman with a long history of renal stones is typical. For several months she complained of flank pain, fever, fatigue, anorexia and weight loss. Laboratory workup found inflammatory anemia and increased erythrocyte sedimentation rate and C-reactive protein levels. Urinalysis showed pyuria and culture grew Escherichia coli. CT scan of the right kidney showed replacement of the renal tissue by several rounded, low-density areas and detected an

obstructive renal stone. Nephrectomy was performed. A, The obstructive renal stone is shown by an arrowhead. The renal cavities are dilated. The xanthogranulomatous tissue (arrows) consists of several round, pseudotumoral masses with a typical yellowish color due to presence of lipids. In some instances such xanthogranulomatous tissue extends across the capsule into the perirenal fat and fistulizes into nearby viscera such as the colon or duodenum. B, Microscopic view of the xanthogranulomatous tissue. This part of the lesion is made of lipid structures composed of innumerable clear droplets.

Spectrum of renal malakoplakla

Inflammation

Persistent inflammation

Defective cell function

Mononuclear cells (nonspecific)

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