Malakoplakia is a rare chronic granulomatous disease generally confined to the urinary bladder, but occasionally occuring in other tissue. Since the initial case of Michaelis-Gutmann in 1902, about 200 cases have been reported. Among these cases,
renal
parenchymal malakoplakia accounts for only 16%. It is most common in middle-aged females with chronic urinary tract infection. The pathogenesis of malakoplakia is nuclear, but defective killing and impaired digestion of phagocytosed bacteria as a
result
of a low GMP/AMP ratio is believed to contribute to its pathogenesis. Improperly digested bacteria becomes mineralized, leading to the formation of the pathognomonic Michaelis-Gutmann bodies.
Renal parenchymal malakoplakia is very rare, and occurs bilateral in about 50% of the cases. Although conservative medical management with an intracellularly active antibiotics, ascorbic acid and a cholinergic agonist has been recommended for
unilateral
renal malakoplakia, nephrectomy has been advocated as the treatment of choice. Bilateral renal malakoplakia behaves as a progressive, destructive, and fatal disease, and little is known about the satisfactory treatment for it.
We experienced a case of renal parenchymal malakoplakia with renal insufficiency in a 66-year-old man. He was admitted for surgery of anal prolapse. On preoperative evaluation, azotemia, pyuria, and an enlarged right kidney were incidentally
detected. A
percutaneous renal biopsy was performed and the specimen showed the characteristic Michaelis Gutmann bodies. After long-term therapy with antibiotics, renal function was recovered partially, pyuria disappeared and the enlarged kidney decreased in
size,
Herein, we report this case with a review of the literatures.
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