Tuberculosis Kidney

Mycobacterium tuberculosis enters the kidney through the hematogenous route. Sometimes kidney tuberculosis can be a manifestation of disseminated tuberculosis.

Pathogenesis

For the occurrence of a tuberculous process in the kidney, in addition to the penetration of mycobacteria, favorable conditions are necessary for them, a special immunopathological state of the body and kidney tissue. The spread of the pathological process to the urinary tract occurs through the lymphatic tract.

Symptoms, course

At the onset of the disease there are no characteristic signs. Complaints of weakness, fatigue, low-grade fever, combined with dull and vague pain in the lumbar region, force a careful examination of the urine. Chronic pyuria is the most common manifestation of renal tuberculosis, but microhematuria can also be an early symptom of the disease.

Urine is almost always acidic, contains many leukocytes, and proteinuria is mild. When urine is cultured on ordinary media, it remains sterile, since mycobacteria displace other flora and do not grow on ordinary media. Pyuria rarely forces the patient to see a doctor; more often he is worried about blood in the urine or attacks of renal colic.

The spread of the pathological process to the urinary tract is accompanied by increased pain in the lumbar region and painful dysuria. Sometimes, with late diagnosis of the disease, the urethra, prostate gland and testicles with appendages are involved in the process.

Diagnosis

The diagnosis is made on the basis of urological examination data, but early recognition is possible if you remember that kidney tuberculosis often occurs under the guise of chronic pyelonephritis, that aseptic pyuria can occur in the presence of Mycobacterium tuberculosis in the urine, and that one of the causes of chronic cystitis is tuberculosis.

Not only pyuria, but also microhematuria, if the cause has not been established with certainty, serve as a reason to re-examine the urine for Mycobacterium tuberculosis (culture on special media, infection of a guinea pig). Detection of Mycobacterium tuberculosis in the urine confirms the diagnosis. A reliable sign of tuberculosis of the urinary system is also the detection of tuberculous tubercles on the mucous membrane of the bladder and signs of cavities on the pyelogram.

If kidney tuberculosis is suspected, the patient is advised to undergo a urological examination.

Treatment

Conservative treatment requires the use of specific anti-tuberculosis drugs (isoniazid 300 mg once a day or rifamycin 300 mg 2 times a day in combination with ethambutol 400 mg 3 times a day) and measures that increase the body's resistance.

Treatment is usually carried out in an anti-tuberculosis dispensary or in special hospitals and sanatoriums (especially in the autumn and spring periods). The polycavernous process requires surgical treatment.

Forecast

With early diagnosis and timely treatment, the prognosis is favorable.