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Diagnosis: Malakoplakia (and Diabetic Nephropathy)

Malakoplakia (some authors write "malacoplakia") is the result of a defect in macrophage function causing impairment of bactericidal activity. The large macrophages that are present at sites of infection (von Hansemann cells) exhibit numerous secondary lysosomes containing partially digested organisms. Calcification of these lysosomes result in the formation of intracytoplasmic bodies called Michaelis–Gutmann bodies, considered pathognomonic of the disease. The term malakoplakia was coined by von Hansemann in 1903 and is derived from the Greek words malakos (soft) and plakos (plaque). Renal parenchymal involvement may produce varying degrees of renal enlargement.

The patient had a history of diabetes mellitus, and histological changes of diabetic nephropathy were identified in nephrectomy (see Figure 2), a factor that could be related to the development of malacoplakia.

See the chapter: Tubulointerstitial Diseases of our Tutorial.

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References

• Ayari Y, Rhouma SB, Zehani A, Chaker K, Abid K, Sellami A, Nouira Y. Renal malakoplakia mimicking a locally advanced renal mass: A case report. Urol Case Rep. 2018;17:117-118. [PubMed link]
• Das DP, Pal DK. Co-existing malakoplakia and xanthogranulomatous pyelonephritis of kidney: Two different spectrum of same disease process. Urol Ann. 2016;8(2):252-4. [PubMed link]
• Wang GQ, Xu XY, Chen YP, Cheng H. Renal Parenchymal Malakoplakia Presenting as Acute Renal Failure in a Young Woman. Chin Med J (Engl). 2016;129(15):1880-1. [PubMed link]
• Graves AL, Texler M, Manning L, Kulkarni H. Successful treatment of renal allograft and bladder malakoplakia with minimization of immunosuppression and prolonged antibiotic therapy. Nephrology (Carlton). 2014;19 Suppl 1:18-21. [PubMed link]
• Keitel E, Pêgas KL, do Nascimento Bittar AE, dos Santos AF, da Cas Porto F, Cambruzzi E. Diffuse parenchymal form of malakoplakia in renal transplant recipient: a case report. Clin Nephrol. 2014;81(6):435-9. [PubMed link]
• Leão CA, Duarte MI, Gamba C, Ramos JF, Rossi F, Galvão MM, David-Neto E, Nahas W, Shikanai-Yasuda MA, Pierrotti LC. Malakoplakia after renal transplantation in the current era of immunosuppressive therapy: case report and literature review. Transpl Infect Dis. 2012;14(6):E137-41. [PubMed link]
• Franco-Alzate C, Prada MC, Arias LF. Massive bilateral nephromegaly in an infant. Kidney Int. 2012;82(7):828. [PubMed link]

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