RENAL TUBERCULOSIS

Renal tuberculosis, a subset of genitourinary tuberculosis, accounts for 15-20% of extra-pulmonary tuberculosis and can result in varied and striking radiographic appearances. Tuberculosis can involve both the renal parenchyma and the collecting system (calyces, renal pelvis, ureter, bladder and urethra).

Commonly it is secondary, Primary may be in the lung.

Tuberculous bacilluria occurs with an early lesion in the renal cortex, and the disease spreads along the ureter causing tuberculous ureteritis and stricture ureter,Through blood, bacteria reach the glomeruli causing caseating granuloma with Langhan’s type of giant cells and epithelioid cells. These granulomas coalesce to form a papillary ulcer and other consecutive different forms.

 TUBERCULOUS KIDNEY RESULTS IN ANY OF THE FOLLOWING PATHOLOGICAL TYPE

• Tuberculous papillary ulcer.
• Cavernous form.
• Hydronephrosis
• Renal tuberculosis [due to (secondary) superadded infection by E. coli, Klebsiella]. x Tuberculous perinephric abscess.
• Calcified tuberculous area (mimics calculi, hence called as pseudocalculi).
• Caseous kidney—often called as putty kidney or cement kidney (it goes for autonephrectomy).
• Miliary tuberculosis.
• Most common site is ureterovesical junction; second common site is pelviureteric junction.
• Tuberculous cystitis eventually results in golf hole ureter and thimble bladder- due to fibrosis causing rigid withdrawn dilated ureteric orifice looking like golf hole.Entire urinary bladder gets fibrosed, stiff and unable to dilate and accommodate urine causing thimble systolic bladder.

CLINICAL FEATURES

• Common in males
• Common on right side.
• Frequency—both day and night.
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• Sterile pyuria: Urine is pale and opalescent with presence of pus cells
• Painful micturition with often haematuria.
• Haematuria may be overt or microscopic (50%).
• Renal pain and suprapubic pain. Suprapubic pain is more common due to cystitis. Tuberculous kidney is rarely palpable unless there is hydronephrosis or perinephric abscess.
• Enlarged prostate and seminal vesicle
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• Haemospermia
• pelvic pain
• Fever and weight loss.
• cough with expectoration

INVESTIGATIONS

• BLOOD EXAMINATION -Hb%. ,ESR.
• Mantoux skin test is usually positive.
• Chest X-ray.
• U/S abdomen.
• URINE – RE , CS
• X-ray KUB—shows calcification.
• CT scan of abdomen and pelvis to see hydronephrosis, shrunken kidney, stricture, necrosis.
• IVU—hydrocalyx, narrowing of calyx, stricture ureter which are often multiple with dilatations in between
• Cystoscopy reveals multiple tubercles, bladder spasm, oedema of ureteric orifice eventually forming “golf hole ureter”, scarring, ulceration, bleeding, stone formation.
• Polymerase chain reaction (PCR) for tuberculosis