Renal tuberculosis

CT REF: Grainger 4^th edition p. 1547/1490

See APPENDIX-63 for list of “Investigations of choice”

• Early renal TB-IVP is most sensitive imaging modality
• Advanced renal TB – CT > IVP > USG ( order of sensitivity)

Ans. is ‘a’ i.e. Intravenous urography 

• In early renal tuberculosis, the only radiological abnormality may be irregularity or destruction of one or more papillae and the most sensitive modality to detect it is IUV as it can show detailed calyceal anatomy.

Advanced changes are:‑

1. Calcification – this may occur in any part of the genitourinary tract, most commonly in the kidney, next in the ureter.
2. Cavities
3. Fibrosis leading to obstruction

• fibrotic strictures of the pelvis or ureters lead to hydronephrosis
• strictures of the calyceal neck lead to hydro calyces (or hydrocalycosis)

      4) Bladder changes

• bladder wall may appear thickened and trabeculated and bladder may be small, contracted. – in later stages, VUR may develop
• Computed tomography shows advanced changes well, but is less sensitive in the early stages as it cannot show detailed calyceal anatomy.

Answer is B (Sterile Pyuria):

The most common clinical presentation of Urological Tuberculosis is Sterile Pyuria.

‘The most common clinical presentation of urological tuberculosis is sterile pyuria and painless hematuria – Textbook of Pulmonary and Critical Care Medicine

`Renal Tuberculosis is probably underdiagnosed because it is frequently asymptomatic Many cases are diagnosed as a result of routine detection of sterile pyuria. The development of symptoms reflects a more advanced stage of disease’ – Oxford Textbook of Medicine

Classical Renal Tuberculosis

Early Clinical Features:

• Symptoms of cystitis;
• Microscopic or macroscopic hematuria;
• Pyuria with negative bacterial culture (`sterile pyuria’);
• Constitutional symptoms.

Late Clinical Features:

• Nephrolithiasis and ureteral colic;
• Intractable frequency and urgency;
• Refractory hypertension;
• Renal insufficiency due to obstructive nephropathy.

Ans. A i.e. Renal pyramid

• Granulomas at renal pyramid –> enlarge (tubercular abscess) –> burst into PC system and pus discharge in urine (sterile pyuria)