Malakoplakia

As Malacoplakia is called a rare chronic inflammatory disease that is associated with macroscopically visible plaque -like or tumor- shaped, gray-white deposits in the area of the kidneys, ureters, or bladder. It can also lead to a diffuse infiltration of the renal parenchyma. The plaques arise primarily in the setting of chronic urinary tract infections, mostly due to coliform bacteria. Often, in addition there is a weakened immune system ( immunodeficiency ) or a malignancy. More rarely other organs such as the gastrointestinal tract, lungs, or skin are affected.

The histologic correlate are large, polygonal shaped macrophages with foamy, eosinophilic cytoplasm (of Hansemannplatz cells). Are pathognomonic PAS positive granular deposits ( granules ), which are called Michaelis Gutmann bodies. It is believed that the Michaelis Gutmann bodies represent the residues of phagosomes containing incompletely digested bacteria and deposits of calcium and iron. The cell defect underlying is likely to kill the decreased ability accommodated bacteria.

Characteristic symptoms include high fever, flank pain, and possibly a palpable tumor. Also, acute renal failure have been described. Frequently first is thought to the histological examination proves the diagnosis of a malignant tumor of the kidney or urinary tract.

The diagnosis of Malacoplakia includes urine culture, blood culture, diagnostic imaging, and cystoscopy with biopsy of the lesions. The treatment of Malacoplakia done with Langzeitantibiose or surgical rehabilitation.

Originally, the prognosis of Malacoplakia was very poor, with the participation of the renal parenchyma, the mortality was about 70 %, with 90 % of survivors, there was a permanent kidney damage. Since 1990, which is preferably treated with Malacoplakia fluoroquinolones, these are antibiotics that penetrate very well into cells. Since then, the prognosis of the disease has greatly improved, the mortality has fallen below 10%, about 25 % leads to a worsening of renal function, surgical therapy is required only in rare cases. However, a prerequisite for a favorable course the rapid histological confirmation of the diagnosis and the prompt start of antibiotic therapy.