Long-Term Burden After Nephrectomy for Xanthogranulomatous Pyelonephritis: A 42-Patient Cohort With Focus on Hard Outcomes

Introduction: Xanthogranulomatous pyelonephritis (XGP) is a rare, destructive renal infection requiring nephrectomy. While perioperative challenges are well described, long-term functional and patient-reported outcomes remain poorly defined. Methods: We conducted a retrospective cohort with prospective HRQoL collection including 42 histopathology-confirmed XGP cases (2010–2023) from a tertiary referral center. Renal function was evaluated using the CKD-EPI 2021 equation at baseline and follow-up (6m, 12m, 3y, 5y). Hard outcomes included postoperative urinary tract infections (UTIs) and all-cause mortality. Health-related quality of life (HRQoL) was assessed at last follow-up using the EQ-5D-5L (Spanish version) with utilities derived from the Mexican 2021 tariff. Results: Median age was 47.0 years (IQR 36.2–61.0); 15.3% were male. Renal function remained stable (ΔeGFR –2.2 mL/min/1.73 m², p = 0.42), and CKD ≥G3 prevalence changed minimally (23.7%→25.4%). At least one postoperative UTI occurred in 22.0%, and mortality was 4.8%. Among 29 patients with HRQoL data, median EQ-5D utility reached 1.00 (IQR 0.90–1.00), with only 13.8% reporting ≥1 problem, mainly mobility. Conclusions: After nephrectomy for XGP, renal function and CKD distribution remain stable, and most survivors report near-perfect health status. Despite the disease’s severity, long-term outcomes are favorable, though UTIs affect one in five. This represents the first survivorship study in XGP integrating contemporary CKD-EPI 2021 assessment and EQ-5D-5L utilities, supporting inclusion of HRQoL metrics in post-nephrectomy follow-up.