| Abstrakt: |
Malakoplakia is a rare granulomatous disease originally described by Michaelis and Gutman in 1902. The genito-urinary tract and in particular the bladder, are most commonly affected, but many other sites have been described (Stanton & Maxted, 1981). Renal parenchymal involvement is relatively uncommon and may be mistaken for neoplastic involvement (Miller & Finck, 1970). We therefore wish to present two cases in which urography, ultrasound and CT were employed before the diagnosis was established by open biopsy.A 52-year-old woman was referred for management of acute renal failure. Three weeks earlier she had been treated for a respiratory tract infection. Three days before admission she had noted that her urine output was falling and complained of dysuria and frequency. There was no haematuria. On examination she was found to have an enlarged tender left kidney. In 1979, she had undergone a right nephrectomy for pyelonephritis and renal calculi.On admission she was pyrexial (38.2°C); her WBC was 13.9 × 106/1, urea 47 mmol/1; the MSU grew E. coliand later streptococcal species. An IVU revealed a space-occupying lesion in the lower and mid pole of the kidney, which distorted the pelvicalyceal system. Ultrasound excluded obstruction and demonstrated a large kidney measuring 15 cm of striking, lobulated appearance with large swollen, transonic and smaller segmental echogenic areas throughout (Fig. 1).CT confirmed the ultrasound findings, demonstrating an extensive, permeating, tumefactive process, separated by islands of normal parenchyma in the mid and lower poles (Fig. 2). |
