RENAL TUBERCULOSIS

• Tuberculosis bacilluria occurs with an early lesion in the renal cortex and disease spreads along ureter causing tuberculous ureteritis and stricture ureter.
• Commonly it is secondary (TB) and primary TB mainly seen in lungs.
• Arises from haematogenous spread.

 

PATHOLOGY-

• Bacteria reach the glomeruli causing caseating granuloma with Langhan’s type of giant cells and epitheloid cells.
• Granulomas at renal pyramid –> enlarge (tubercular abscess) –> burst into PC system and pus discharge in urine (sterile pyuria) 
• Granulomas forms are-

a) Tuberculous papillary ulcer

b) Cavernous form

c) Hydronephrosis

d) Pyenephrosis

e) Tuberculous perinephric abscess

f) Calcified tuberculous area (pseudocalculi)

g) Caseous kidney (putty kidney or cement kidney)

h) Tuberculous bacilluria occurs in ureterovesical junction

i) Tuberculous cystitis

 CLINICAL FEATURES-

• Men are more affected
• 2^nd and 4^th decade
• Common on right side
• Polyuria, sterile pyuria
• Painful micturition with often haematuria
• Renal pain and suprapubic pain
• Enlarged prostate and seminal vesicle
• Acute pyelonephritis
• Urinary stones, recurrent UTI, renal failure
• Haemospermia, pelvic pain
• Dyspareunia, menstrual dysfunction, vaginal discharge
• Fever and weight loss
• Expectoration and haemoptysis
• Tuberculous kidney is rarely palpable

INVESTIGATIONS-

1. Decrease Hb
2. Increase ESR (Montoux test is usually positive)
3. Plain X- ray, KUB- shows calcification
4. IVU-

• Indistinct outline of renal papilla is the early sign
• Later calyceal necrosis
• Contracted bladder

    5. Cystoscopy-

• Reveals multiple tubercles bladder spasm, oedema of ureteric orifice forming golf hole ureter.
• Thimble bladder

    6. PCR- tuberculosis

 TREATMENT-

1. Antitubercular therapy
2. Operative treatment-

• Removes large foci of infection which are difficult to treat with drugs
• Corrects obstruction caused by fibrosis (6 and 12 weeks after starting ATT)
• Pyeloplasty- strictured renal pelvis
• Boari operation or bowel interposition- ureteric stenosis and shortening
• Nephroureterectomy- non functioning kidney

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