|LETTER TO EDITOR
|Year : 2015 | Volume
| Issue : 3 | Page : 308
Chronic pyelonephritis continues to be the leading cause of nephrectomies
Department of Pathology, Prasad Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
|Date of Web Publication||12-Jun-2015|
Department of Pathology, Prasad Institute of Medical Sciences, Lucknow, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Awasthi N. Chronic pyelonephritis continues to be the leading cause of nephrectomies. CHRISMED J Health Res 2015;2:308
Renal diseases are an important cause of morbidity worldwide. The indications of nephrectomy range from inflammatory lesions causing extensive parenchymal damage to benign and malignant tumors. A retrospective evaluation of 2 years and 4 months duration from March 2012 to July 2014 was done in a tertiary care hospital associated with a Medical College in Lucknow, to study the histopathological profile of nephrectomies. Clinical details and histopathological data were retrieved from the hospital records. The surgically resected nephrectomy specimens were examined in detail grossly. Sections were taken for microscopic examination as per the standard protocol. Additional sections were taken in cases where some gross pathology was evident. Routine processing and staining by hematoxylin and eosin stain was done, followed by a thorough microscopic examination.
There were 14 nephrectomy specimens received over a period of 28 months. Male to female ratio was 2.5:1. Age of the patients ranged in between 28 and 75 years with a mean age of 44.4 ± 14.8 years. Clinical impression based on imaging studies was of a malignant lesion in two cases while rest was sent with a clinical diagnosis of poorly/nonfunctioning kidney. All cases were classified microscopically on the basis of the predominant lesion seen. Pyelonephritis emerged as the main histopathological entity and accounted for 11 cases (78.6%) while malignant tumors were seen in 3 (21.4%). This finding was consistent with other studies. ,, of Aiman A et al., El Malik EM et al., Nggada et al. Aiman A et al. and El Malik EM et al. reported 22.8 and 22% malignant lesions in their studies on 140 and 85 nephrectomies, respectively.
Of 11 cases of pyelonephritis, 8 (72.7%) were chronic pyelonephritis, 2 (18.2%) were xanthogranulomatous pyelonephritis (XPN) while 1 (9.1%) was Acute on Chronic pyelonephritis. XPN constituting 18.2% of all cases of pyelonephritis was consistent with a study by Korkes et al.  but was higher than that reported by several other studies.  The importance of recognizing this variant of chronic pyelonephritis lies in the fact that it can be mistaken on clinical or gross examination, and sometimes even at the microscopic level for renal cell carcinoma. Because of the space occupying the nature of this lesion, a correct preoperative diagnosis may not be possible.  Of the three malignant tumors, one was a renal cell carcinoma of clear cell type while two were poorly differentiated urothelial carcinomas of the pelvicalyceal system. One of the two poorly differentiated urothelial carcinomas was incidentally detected on gross examination.
Chronic pyelonephritis and its variants still continue to be the leading cause of nephrectomies despite the advent of newer and more effective antibiotics. Pyelonephritis of long standing duration, in the absence of proper treatment, can predispose to malignancies of kidney and the upper urinary tract. Prompt and effective management of recurrent urinary tract infections and obstructive nephropathy, which are the root cause in the pathogenesis of Pyelonephritis, can go a long way in reducing the need of nephrectomies.
| References|| |
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