■黄色肉芽肿性肾盂肾炎(XGP)是一种罕见的疾病,由肾实质的破坏性慢性炎症过程组成,并伴有反复感染和尿路阻塞。腹膜透析(PD)是一种用于晚期肾脏疾病的肾脏替代疗法。PD患者表现出全身炎症状态,继发于尿毒症毒素的增加,促炎细胞因子的过滤减少,以及不断暴露于生物不相容的透析液或来自导管的异物反应,在其他因素中,作为腹膜感染。
■我们介绍了一个74岁女性的临床病例,有与肾结石和5D慢性肾病相关的复发性尿路感染史,在一个PD项目上。患者出现非特异性的3个月的进行性衰弱状态,分析对照中炎症参数增加。在出现多个阴性尿培养和腹膜液培养后,她住院研究体质综合征。影像学检查显示双侧鹿角结石,右肾盂严重扩张,皮质变薄。鉴于XGP的怀疑,决定进行右肾肾切除术,解剖病理学研究后证实了这一点。在干预之前,她被转入血液透析.在接下来的几个月里,观察到显著的临床和分析改善.
■PD患者的全身炎症状态和感染风险可掩盖PD患者XGP的诊断。PD患者中没有XGP病例的报道。
UNASSIGNED: Xanthogranulomatous pyelonephritis (XGP) is a rare illness that consists of a destructive chronic inflammatory process of the renal parenchyma associated with recurrent infection and obstructions of the urinary tract. Peritoneal dialysis (PD) is a form of renal replacement therapy used in advanced kidney disease. PD patients demonstrate a systemic inflammatory state, secondary to the increase in uremic toxins, decreased filtration of proinflammatory cytokines, as well as constant exposure to bioincompatible dialysis solutions or a foreign body reaction from the catheter, among other factors, as peritoneal infections.
UNASSIGNED: We present the clinical case of a 74-year-old woman, with a history of recurrent urinary tract infections associated with nephrolithiasis and stage 5D chronic kidney disease, on a PD program. The patient presented a non-specific 3-month state of progressive asthenia, with increased inflammatory parameters in the analytical controls. After presenting multiple negative urine cultures and peritoneal fluid cultures, she was hospitalized to study the constitutional syndrome. The imaging test revealed bilateral staghorn lithiasis with severe dilatation of the right renal pelvis and great cortical thinning. Given the suspicion of XGP, it was decided to perform right renal nephrectomy, which was confirmed after the anatomopathological study. Prior to the intervention, she was transferred to hemodialysis. Over the following months, significant clinical and analytical improvement was observed.
UNASSIGNED: The systemic inflammatory state and the risk of infections in PD can mask the diagnosis of XGP in PD patients. There are no reported cases of XGP in patients in PD.