V08_No_3_Final.pdf


Clinical Pathology Case

236 Urology Journal    Vol 8    No 3    Summer 2011

An Unusual Presentation of an Uncommon Renal 
Disease
Farzaneh Sharifiaghdas, Hossein Kilani, Seyed Amin Mirsadeghi

Urol J. 2011;8:236-8. 
www.uj.unrc.ir

Shahid Labbafinejad Medical 
Center, Shahid Beheshti University 

of Medical Sciences, Tehran, Iran

Corresponding Author:

Farzaneh Sharifiaghdas, MD 
Shahid Labbafinejad Medical 

Center, Shahid Beheshti University 
of Medical Sciences, Tehran, Iran

Tel/Fax: +98 21 2258 8016 
E-mail: fsharifiaghdas@yahoo.com

CASE PRESENTATION
A 59-year-old man presented with 
non-specific right flank pain two 
years earlier. Ultrasonography and 
intravenous urography revealed 

right staghorn renal calculi. 
Thereafter, he underwent right 
open nephrolithotomy and stone-
free condition was confirmed by 
follow-up imaging.

Figure 1. Intravenous pyelogram demonstrating no excretion on the right side.



Clinical Pathology Case

237Urology Journal    Vol 8    No 3    Summer 2011

After 18 months, the patient presented with the 
same chief complaint. Small size (10 mm) stone 
of the right side of the pelvis was diagnosed, 
which was treated with extracorporeal shockwave 
lithotripsy at one session. Two weeks later, he 
developed chills, high fever, and severe flank pain. 
Ultrasonography showed right pyonephrosis, 
which was drained as an outpatient surgery by 
placing untrasound-guided nephrostomy catheter. 
A large amount of pus was drained and the patient 
became symptom-free. Intravenous urography 
revealed non-functional right kidney (Figure 1), 
which was confirmed by diethylene triamine 
pentaacetic acid (DTPA) scan (split function of 
11.6% and 88.4% for the right and left kidneys, 
respectively). Right side ureteral obstruction was 
also demonstrated in DTPA scan (Figure 2).

With the suspicion of obstruction made by small 
particles of fragmented stones, ureteroscopy was 
performed, which was unremarkable. Double-J 
stent was inserted and nephrostomy tube was 
removed 2 days later. The patient became 
symptomatic again after double-J stent insertion 
and experienced several episodes of urinary tract 
infection, following which double-J stent was 
removed.

Follow-up computed tomography scan showed 
severe right upper pole caliectasis and moderate 
right hydronephrosis with deformation 
of the pyelocalyceal system suspicious for 
xanthogranulomatous pyelonephritis (Figure 3). 
Due to frequent relapses of symptoms and signs, 
the patient underwent right simple nephrectomy. 

Figure 2. Poor perfusion and function of the right kidney in renal DTPA scan.



Clinical Pathology Case

238 Urology Journal    Vol 8    No 3    Summer 2011

QUIZ
Do you agree with the approach chosen for the 
diagnosis or do you recommend other imaging 
studies or procedures?

What do you think the final pathology report of 
the specimen might be?

The answers will be discussed in the next issue of 
Urology Journal.

Figure 3. Abdominal computed tomography scan with 
intravenous contrast suspicious for xanthogranulomatous 
pyelonephritis.