Edit concept Question Editor Create issue ticket

Renal Tuberculosis

Renal Tuberculoses

Renal tuberculosis is one of the most common forms of extrapulmonary infection by Mycobacterium tuberculosis, usually developing as a result of hematogenous dissemination from the lungs. Hematuria, nocturia, and abdominal or pelvic pain are main symptoms. The diagnosis is made through a comprehensive clinical assessment, urinalysis, and imaging studies such as abdominal ultrasonography, invasive renal procedures, and computed tomography, whereas microbiological studies - cultivation, or polymerase chain reaction (PCR) testing, is necessary as well.


Presentation

With approximately 9 million new cases being diagnosed each year, tuberculosis is globally an important disease that is primarily causing infections in the African and Asian continents, and only a minority of patients are from Europe and the United States of America [1] [2]. Apart from pulmonary tuberculosis, many extrapulmonary forms of the disease have been described in the literature, and one of the most important and most common is renal tuberculosis, comprising from 15%-27% of all extrapulmonary cases [1] [2] [3]. The pathogenesis stems from hematogenous spread of M. tuberculosis from the lungs to the kidneys, often in the absence of symptoms that could suggest an ongoing process in the pulmonary system [1]. After a variable incubation period, the clinical presentation of renal tuberculosis resembles a urinary tract infection (UTI) - dysuria, nocturia, pain in the flank, abdomen, or pelvis [1] [2] [3] [4]. Hematuria, appearing as an isolated symptom, is an important clue toward renal tuberculosis, but it may also be accompanied by proteinuria and sometimes pyuria [2] [3] [4]. Typical symptoms encountered in pulmonary tuberculosis, such as fever, weight loss, and night sweats are uncommon [1]. However, more severe infections can lead to marked kidney damage, resulting in obstructive uropathy and loss of kidney function that progresses to renal failure and end-stage renal disease [2] [3] [5]. For this reason, an early diagnosis is vital.

Chills
  • Other symptoms include chills, fever and frequent urination, sometimes there can be blood in the urine (this is called hematuria). Renal tuberculosis can be classified using two criteria.[tuberculosistreatment.blogspot.com]
  • Case Presentation A 25-year-old adult male was admitted to hospital with complaints of continuous low grade fever since 2 months with chills, rigors and sweating. Patient complained of cough since 15 days and vomiting.[pubs.sciepub.com]
  • Signs and symptoms of active TB include: Coughing that lasts three or more weeks Coughing up blood Chest pain, or pain with breathing or coughing Unintentional weight loss Fatigue Fever Night sweats Chills Loss of appetite Tuberculosis can also affect[mayoclinic.org]
Left Flank Pain
  • Abstract A 74-year-old woman presented with a 3-day history of fever and left flank pain. The imaging study revealed a huge complicated cyst in the left kidney. The cyst had a mass effect to the abdomen.[ncbi.nlm.nih.gov]
Right Flank Pain
Subcutaneous Nodule
  • Abstract Erythema induratum of Bazin is a disease that usually affects women, in whom erythematous subcutaneous nodules and plaques appear on the posterior part of the lower extremities, some of which ulcerate.[ncbi.nlm.nih.gov]
Dysuria
  • Six months later the patient had complaints of abdominal pain and dysuria. New laboratorial tests showed serum urea 187 mg/dL, creatinine 8.0 mg/dL, potassium 6.5 mEq/L. Hemodialysis was then started.[ncbi.nlm.nih.gov]
  • Few months later she presented adynamia and urinary complaints, such as polacyuria and dysuria. It has been done an urynalysis, which demonstrated acid pH urine, sterile pyuria and microscopic hematuria.[ncbi.nlm.nih.gov]
  • In the urinary incontinence at the same time there is urgency, dysuria. 2. Hematuria, which is another important symptom of renal tuberculosis incidence rate of about 70%.[tcmwell.com]
  • The onset of clinically evident genitourinary tuberculosis is often insidious, with dysuria and gross hematuria being the most common symptoms [6].[scielo.br]
  • After a variable incubation period, the clinical presentation of renal tuberculosis resembles a urinary tract infection (UTI) - dysuria, nocturia, pain in the flank, abdomen, or pelvis.[symptoma.com]
Flank Pain
  • CONCLUSIONS: While gross hematuria is more prevalent in older patients and male patients, flank pain is more common in female patients.[ncbi.nlm.nih.gov]
  • We report the case of a 44-year-old woman referred for hydronephrosis discovered on ultrasound performed due to flank pain.[ncbi.nlm.nih.gov]
  • Abstract A 74-year-old woman presented with a 3-day history of fever and left flank pain. The imaging study revealed a huge complicated cyst in the left kidney. The cyst had a mass effect to the abdomen.[ncbi.nlm.nih.gov]
  • Figure 1: 34-year-old woman with intermittent right flank pain diagnosed with genitourinary tuberculosis.[clinicalimagingscience.org]
  • Clinical features are often nonspecific and include: hematuria flank pain constitutional symptoms Diagnosis can be obtained by culturing multiple first-morning-void urine samples, or by histology of imaging guided biopsy or surgical specimens, although[radiopaedia.org]
Urinary Incontinence
  • Advanced bladder contracture, capacity is small and up to dozens of daily frequency of urination, and even showed the phenomenon of urinary incontinence. In the urinary incontinence at the same time there is urgency, dysuria. 2.[tcmwell.com]

Workup

With a properly obtained patient history and a detailed physical examination, sufficient evidence may be obtained to pursue a diagnosis of renal tuberculosis. As immunosuppression is one of the main risk factors for an infection by M. tuberculosis, patients should be asked about underlying illnesses (for example, human immunodeficiency virus infection, transplantation, dialysis, etc.) [1], but also if they already suffered from tuberculosis, since about 25% of cases were previously diagnosed with pulmonary tuberculosis [4]. After assessing the presence of signs and symptoms that are further evaluated during the physical examination, a full laboratory workup and urinalysis should be performed. In addition to hematuria and proteinuria, sterile pyuria is a hallmark of tuberculosis, in which case more advanced microbiological studies are necessary. Acid-fast staining (by using Ziehl-Neelsen stain) and cultivation of at least three urine samples obtained in the morning on the Lowenstein-Jensen medium are highly successful methods for detecting M. tuberculosis, yielding a positive rate of up to 95% [2] [3] [4]. But as mycobacteria grow very slowly on these media, approximately 6-8 weeks need to pass before a definite diagnosis can be made, which is why more advanced methods that detect bacterial DNA (like PCR) are often used [2]. Imaging procedures (ultrasonography, computed tomography, magnetic resonance imaging, intravenous urography, chest X-rays) are equally important for assessing the status of the kidneys and potentially reveal any pathological lesions [1] [2] [3] [4] [6].

Nephrolithiasis
  • Abstract Xanthogranulomatous pyelonephritis (XGPN) is a chronic renal infection typically associated with nephrolithiasis and a non-functioning kidney. Renal tuberculosis is a major cause of morbidity in developing countries.[ncbi.nlm.nih.gov]
Pyuria
  • Most patients with renal TB have sterile pyuria, which can be accompanied by microscopic hematuria. The diagnosis of urinary tract TB is based on the finding of pyuria in the absence of common bacterial infection.[ncbi.nlm.nih.gov]
  • We found renal tuberculous granuloma in 11 (23%) patients (in 3 without previous diagnosis of renal or extrarenal tuberculosis) and only 4 of them presented moderate hematuria or pyuria sterile.[ncbi.nlm.nih.gov]
  • In addition to hematuria and proteinuria, sterile pyuria is a hallmark of tuberculosis, in which case more advanced microbiological studies are necessary.[symptoma.com]
  • RESULTS: After 1 year of treatment, the patient recovered completely; pyuria and hematuria disappeared with negative acid-fast bacteria urine culture. The patient has been followed up for 2 years without recurrence.[ncbi.nlm.nih.gov]
  • It has been done an urynalysis, which demonstrated acid pH urine, sterile pyuria and microscopic hematuria. It was then raised the diagnostic hypothesis of renal tuberculosis.[ncbi.nlm.nih.gov]

Treatment

  • Evidence of ureteric obstruction was obtained in 30 patients (50%)--23 at the time of diagnosis, 6 during treatment and 1 at the time of relapse. Following corticosteroid treatment relief of obstruction was obtained in 72%.[ncbi.nlm.nih.gov]
  • Emphasis is laid upon the necessity of a careful observation of the patients with renal tuberculosis in the course of drug treatment in view of a timely detection and treatment ofthe strictures in the draining urinary pathways.[ncbi.nlm.nih.gov]
  • , especially in patients who had received such a treatment which induced an immunocompromised state.[ncbi.nlm.nih.gov]
  • Radical, extirpative surgery has a smaller part to play than chemotherapy in the treatment of renal tuberculosis.[ncbi.nlm.nih.gov]
  • While ethambutol treatment is most commonly instituted for pulmonary tuberculosis, it is interesting to note that both of these patients had renal tuberculosis.[ncbi.nlm.nih.gov]

Prognosis

  • […] pyelonephritis Papillary necrosis Medullary sponge kidney Xanthogranulomatous pyelonephritis Treatment Anti-tuberculous drugs Nephrectomy Complications Untreated, end result is autonephrectomy Infertility in females Sinus and fistula tract formation Prognosis[learningradiology.com]
  • The occurrence of ureteral calcification along with renal calcifications further proves the diagnosis of lobar presentation and generally has unfavorable prognosis. [1] , [3] Intravenous urogram is regarded as the investigations of choice that provides[indianjnephrol.org]
  • […] involvement or due to hydronephrosis end-stage progressive hydronephrosis results in very thin parenchyma, mimicking multiple thin walled cysts amorphous dystrophic calcification eventually involves the entire kidney (known as putty kidney ) Treatment and prognosis[radiopaedia.org]
  • Prognosis Most patients who are treated for TB with the recommended course of antimicrobials recover without relapse. Patients need to take all the medications for the entire 6 to 9 months of therapy. DOT is the preferred strategy.[renalandurologynews.com]

Etiology

  • In many countries, tuberculosis is still the main etiologic factor. We report a case of a 40-year-old woman who presented a course of protracted and recurrent episodes over five years of cutaneous lesions on her legs.[ncbi.nlm.nih.gov]
  • Vijaykumar, Sumanth Bhoopal Indian Journal of Surgery. 2012; 4 Etiology and management of genitourinary tuberculosis Aula Abbara, Robert N. Davidson Nature Reviews Urology. 2011; 8(12): 678[indianjurol.com]
  • Etiology of spontaneous perirenal hemorrhage: a meta-analysis. J Urol 2002;167:1593-96.[tmj.ro]
  • Frequency and etiology of gross hematuria in a general pediatric setting. Pediatrics. 1977;59(4):557-61 19. Dhua AK, Borkar N, Ghosh V, Aggarwal SK. Renal tuberculosis in infancy. J Indian Assoc Pediatr Surg. 2011Apr;16(2):69-71 20.[degruyter.com]
  • Etiology of Urogenital Tuberculosis Causative agent of tuberculosis: Mycobacterium tuberculosis is a 1–2 microns long immobile bacillus. Other features include: acid-resistant, intracellular persistence in phagocytes, doubling time 20 hours.[urology-textbook.com]

Epidemiology

  • Abstract The epidemiology of renal tuberculosis is characterised by a considerable variation in the frequency and distribution of the infection.[ncbi.nlm.nih.gov]
  • Haydarnejad H, Ashrafi H. epidemiologic study of tuberculosis in Tabriz, a 10 years study.Ashrafi H, MD Thesis. 1997; Faculty of medicine, Tabriz University of medical science. Page 17 (thesis is in Persian) 5. Nourizadeh D, Madaen K, Gaderian N.[sjkdt.org]
  • Male genital tuberculosis: Epidemiology and diagnostic. World J Urol 2012;30:15-21. 5. Lima NA, Vasconcelos CC, Filgueira PH, Kretzmann M, Sindeaux TA, Feitosa Neto B, et al.[clinicalimagingscience.org]
  • Epidemiology of urogenital tuberculosis worldwide. International Journal of Urology 2008; 15: 827-832. In article CrossRef [5] Gow JG. Genitourinary tuberculosis. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ (eds). Campbell’s urology. V.1, 7a edn. W.[pubs.sciepub.com]
  • Epidemiology of urogenital tuberculosis worldwide. Int J Urol. 2008;15(9):827-32 5. Rai A, Pahwa H, Jain V, Misra S. Management of Genito-Urinary Tuberculosis. The Internet Journal of Surgery 2010;23(1). DOI: 10.5580/173a 6.[degruyter.com]
Sex distribution
Age distribution

Pathophysiology

  • This article gives review of pathophysiology and computed tomography features of Renal TB. This is a preview of a remote PDF: Ashwini Sankhe, Anagha R. Joshi.[paperity.org]
  • Pathophysiology Infection with M tb produces tuberculosis. The most common site involved is the lung, but tuberculosis may involve any organ, may be disseminated or may be asymptomatic. The pathogenesis of tuberculosis is a two-stage process.[renalandurologynews.com]
  • Risk factors for active tuberculosis: Immigrants Alcoholism Old age AIDS Diabetes mellitus Steroid therapy Intravenous drug abuse Smoking Lung diseases: Silicosis, COPD Malnutrition Malignant diseases Gastric resection Crowding, e.g. prisons Pathophysiology[urology-textbook.com]

Prevention

  • Our preventive examinations indicated that nephrotuberculosis can be actively and earlier detected not only in patients with extrarenal tuberculosis but in persons cured from it, and in patients with local urogenital lesions.[ncbi.nlm.nih.gov]
  • Factors concerned with prevention in high risk groups are discussed.[ncbi.nlm.nih.gov]
  • In countries in which tuberculosis is endemic, it is important to have a high index of suspicion for tuberculosis in patients with renal calcifications in order to facilitate treatment and to prevent autonephrectomy.[nejm.org]
  • Our preventive examinations indicated that nephrotuberculosis can be actively and earlier detected not only in patients with extrarenal tuberculosis but in persons cured from it, and in patients with local urogenital lesions. 1975 S.[karger.com]

References

Article

  1. Eastwood JB, Corbishley CM, Grange JM. Tuberculosis and the kidney. J Am Soc Nephrol. 2001;12(6):1307-1314.
  2. Daher Ede F, da Silva GB Jr, Barros EJ. Renal Tuberculosis in the Modern Era. Am J Trop Med Hyg. 2013;88(1):54-64.
  3. de Oliveira JL, da Silva Junior GB, Daher Ede F.
    Tuberculosis-associated chronic kidney disease. Am J Trop Med Hyg. 2011;84:843–844.
  4. Gibson MS, Puckett ML, Shelly ME. Renal tuberculosis. Radiographics. 2004;24(1):251-256.
  5. Daher Ede F, Silva Júnior GB, Damasceno RT, et al. End-stage renal disease due to delayed diagnosis of renal tuberculosis: a fatal case report. Braz J Infect Dis. 2007;11:169–171.
  6. Jung YY, Kim JK, Cho KS. Genitourinary tuberculosis: comprehensive cross-sectional imaging. AJR Am J Roentgenol. 2005;184(1):143-150.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2018-06-22 05:51