Kidney nontumor
Tubular and interstitial diseases
Xanthogranulomatous pyelonephritis

Author: Nikhil Sangle, M.D. (see Authors page)

Revised: 26 March 2018, last major update August 2014

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Xanthogranulomatous pyelonephritis

Cite this page: Sangle, N. Xanthogranulomatous pyelonephritis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/kidneyxantho.html. Accessed July 23rd, 2018.
Definition / general
Clinical features
  • Destructive inflammatory process that may complicate chronic pyelonephritis
  • Usually unilateral, ages 40+, 2/3 women
  • Associated with pelvicalyceal obstruction and ulceration
  • Rarely coexists with squamous cell carcinoma (J Cancer Res Ther 2010;6:339), renal cell carcinoma (ScientificWorldJournal 2009;9:5)
Case reports
Gross description
  • Multiple yellow nodules around calyces, may form a mass and be infiltrative
Gross images

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Microscopic (histologic) description
  • Replacement of renal parenchyma with CD68+ foamy histiocytes, occasional multinucleated giant cells and inflammatory cells
Microscopic (histologic) images

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CD68


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Liesegang rings


Differential diagnosis
  • Malakoplakia: Michaelis-Gutmann bodies
  • Renal clear cell carcinoma: Cells with clear cytoplasm may resemble histiocytes, but are keratin+, CD68-; arranged in compact, tubulocystic, alveolar or rarely papillary patterns; often glassy hyaline globules; usually nuclear grade 2 or higher; chicken wire / delicate vasculature is common (sinusoids near each packet of cells)
  • Renal replacement lipomatosis: atrophic renal parenchyma is replaced by fatty tissue, not xanthoma cells (Rev Assoc Med Bras 2011;57:262)