Sheela, a middle aged diabetic female presented with flank pain and fever. On U/S the kidney was irregular and showed fat density with calculi. The diagnosis is most probably:

Ans. (b) Xanthogranulomatous kidneyRef: Smith 17th Edition, Pages 204-206; Campbell 10th Edition, Page 308Xantho Granulomatous pyelonephritis (XGP)* Xantho means lipid foam cells* Xanthogranulomatous pyelonephritis is a variant of chronic pyelonephritis that characteristically presents in middle aged patients with a poorly functioning kidney (as in diabetic)* On histology there are areas of clear cells that are lipid-laiden macrophages* These areas of lipid-laiden macrophage appear as fat density lesion on U/S* This pyelonephritis is often accompanied by a calculus and proteus infection.* Kidney sparing surgery is indicated for XGP.