A 60-year-old woman presents with progressive difficulty voiding and recurrent UTIs. CT shows a staghorn calculus in the right kidney with a non-functioning, thinned parenchyma. Biopsy of the renal parenchyma shows foamy macrophages and multinucleated giant cells with chronic inflammation. What is the definitive management?
- A Extracorporeal shock wave lithotripsy
- B Nephrectomy ✓
- C Percutaneous nephrolithotomy with antibiotics
- D Long-term antibiotic suppression alone
Correct answer: B. Nephrectomy
Explanation
Xanthogranulomatous pyelonephritis is a chronic inflammatory condition associated with long-standing obstruction (typically staghorn calculus) characterized by lipid-laden macrophages. It destroys renal parenchyma and mimics renal cell carcinoma. Definitive treatment is nephrectomy since the kidney is non-functioning and the inflammatory process is irreversible. ESWL or PCNL is insufficient.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.