Gross Hematuria Is More Common in Male and Older Patients with Renal Tuberculosis in China: A Single-Center 15-Year Clinical Experience.

OBJECTIVES: This study aimed to investigate the clinical features of renal tuberculosis and identify the age- and gender-related differences. METHODS: A total of 419 patients at the Peking University First Hospital from January 2000 to July 2015 were retrospectively reviewed. Data on demographic characteristics, clinical presentation, complications, laboratory results, radiologic imaging, surgical procedures, and pathology features were collected and compared between genders and 3 different age groups (under 40 years, 41-60, years and over 60 years). RESULTS: The most common local presentations were lower urinary tract symptoms (65.2%), flank pain (37.9%), and gross hematuria (26.3%). Constitutional symptoms were also observed in 38.9% of the patients. Gross hematuria was more common in male patients (32.2%) and older patients (45.5%). Flank pain was more common in female patients (43.6%). Patients younger than 40 years of age had lower frequencies of calcification of the urinary tract (22.2%) and kidney atrophy (4.2%) in CT. In the postoperative pathological reports, atrophy (35.9%) and fibrosis (38.5%) were found to be significantly more common in older patients. CONCLUSIONS: While gross hematuria is more prevalent in older patients and male patients, flank pain is more common in female patients. Radiological and pathological features including calcification of the urinary tract, fibrosis, and kidney atrophy are more common in older patients.

Disseminated kidney tuberculosis complicating autosomal dominant polycystic kidney disease: a case report.

Mycobacterium tuberculosis infection in patients with autosomal dominant polycystic kidney disease (ADPKD) is rare, and its diagnosis and treatment are difficult because numerous cysts are exposed to infection and antibiotics do not easily penetrate infected cysts. Here, we report the case of a 43-year-old Japanese man with disseminated urogenital tuberculosis (TB) and ADPKD without human immunodeficiency virus (HIV) infection. Delayed diagnosis and ineffective anti-TB chemotherapy worsened his condition. Finally, he underwent bilateral nephrectomy but experienced postoperative complications. In conclusion, kidney TB should be recognized as a cause of renal infection in ADPKD, and surgical treatment should be instituted without delay. The importance of early diagnosis and treatment cannot be overemphasized to prevent kidney TB deterioration.

Can tissue PCR augment the diagnostic accuracy in genitourinary tract tuberculosis?

PURPOSE: Conventional methods like smear and culture for Mycobacterium tuberculosis are of limited sensitivity and specificity. Histopathological examination (HPE) for the tissues obtained gives inconclusive diagnosis in the absence of caseous necrosis or stained acid-fast bacilli. This study was conducted to determine the utility of tissue PCR for diagnosing tuberculosis of the genitourinary tract (GUTB) and its comparative evaluation with HPE. PATIENTS AND METHODS: A prospective study was conducted from January 2006 to August 2009 with 78 tissue specimens (renal, prostate, epididymis, penile and soft tissue) from patients with clinically suspected GUTB. All the samples were processed for both PCR and histopathology. RESULTS: In 68 (87.1%) samples, results for both PCR and HPE were coinciding. False positivity and false negativity was observed in 5.1% (4/78) and 7.6% (6/78) samples, respectively. With HPE as the gold standard, PCR has shown sensitivity of 87.5% (95% CI 80.1; 91.9) and specificity of 86.7% (95% CI 74.9; 93.8) and positive agreement between two tests was observed as significant (0.7). PCR results were obtained within a mean period of 3.4 days while those of HPE were obtained in 7.2 days. CONCLUSIONS: Tissue PCR is a sensitive and specific method for obtaining early and timely diagnosis of GUTB. Application of tissue PCR results can augment the diagnostic accuracy in histopathologically labelled granulomatous inflammations.

Presentation, diagnosis, and treatment outcome of tuberculous-mediated tubulointerstitial nephritis.

Insidious Mycobacterium tuberculosis infection causing tubulointerstitial nephritis is a rare disorder. Here we report on a single-center case series of patients with tubulointerstitial nephritis due to tuberculosis, addressing clinicopathologic features and treatment outcome. Twenty-five adult patients with clinical evidence of tuberculosis and significant renal disease were assessed, 17 of whom had a kidney biopsy and were subsequently diagnosed with chronic granulomatous tubulointerstitial nephritis as the primary lesion. All patients were given standard antitubercular treatment, with some receiving corticosteroids, and showed a good response in clinical symptoms and inflammatory markers. Nine of the 25 patients, however, started renal replacement therapy within 6 months of presentation. Of the remaining 16, renal function improved for up to a year after presentation but subsequently declined through a median follow-up of 36 months. This case series supports that chronic tubulointerstitial nephritis is the most frequent kidney biopsy finding in patients with renal involvement from tuberculosis. Thus, a kidney biopsy should be considered in the clinical evaluation of kidney dysfunction with tuberculosis since tubulointerstitial nephritis presents late with advanced disease. A low threshold of suspicion in high-risk populations might lead to earlier diagnosis and treatment, preserving renal function and delaying initiation of renal replacement therapy.

Tuberculosis and tubulointerstitial nephritis: an intriguing puzzle.

Classical renal tuberculosis is a well-known cause of urinary tract scarring and calcification, and sometimes renal dysfunction. In the past two decades there have been reports, particularly from the United Kingdom among immigrants from the Indian subcontinent, of a more insidiously progressive form of renal disease. Ultrasound shows small smooth kidneys, and histology reveals tubulointerstitial nephritis including granulomas but not acid-fast bacilli. Evidence is mounting that the underlying cause may be tuberculosis, but the mechanism remains obscure.

Mycobacterium tuberculosis infection of a native polycystic kidney following renal transplantation.

Tuberculosis is a recognized complication following renal transplantation. Patients with autosomal-dominant polycystic kidney disease are increasingly being offered renal transplantation as an alternative to chronic hemodialysis. These patients are uniquely susceptible to serious upper urinary tract infections that are associated with significant morbidity and mortality. While involvement with gram-negative organisms is well described, mycobacterial infection of native polycystic kidneys after transplantation has not been addressed. We report a case of a renal transplant recipient who suffered an isolated Mycobacterium tuberculosis infection of a native polycystic kidney. With a 4-drug anti-tuberculosis therapy (ATT) regimen, the patient responded and became afebrile 8 weeks after initiation of drug therapy. ATT was continued for a total of 1 year. Two years after completion of ATT, the patient enjoys a normal life and has stable graft function. M. tuberculosis, though not common, must be recognized as a potential source of infection of native polycystic kidneys in immunocompromised transplant recipients. Similar to the pattern observed with more common pathogens, these infections may be difficult to eradicate with standard antimicrobial drug regimens.

[Bacteriological diagnosis of renal tuberculosis: an experience at the regional tuberculosis laboratory in Córdoba Province, Argentina]. / Diagnóstico bacteriológico de tuberculosis renal: experiencia del Laboratorio Regional de Tuberculosis de la provincia de Córdoba.

Given the incidence of renal tuberculosis in patients suffering of pulmonary tuberculosis, we seek to study both the frequency of this association in diagnosed cases of renal tuberculosis and the Mycobacterium tuberculosis complex species that were identified (period 1997-2009), observing its incidence by sex, demonstrating the importance of serial culture of urine samples and evaluating the convenience of using solid and liquid media. The analysis of urine samples from 383 patients indicated renal tuberculosis in 24 cases; in most cases, (95.8 %) Mycobacterium tuberculosis complex species prevailed, whereas the presence of Mycobacterium bovis accounted for 4.2 % of the cases. The association of pulmonary and renal tuberculosis was found in 6 cases. The isolation of Mycobacterium bovis indicates the importance of including Stonebrink medium along with Lowenstein- Jensen medium. The liquid medium made no significant contribution to the diagnosis of renal tuberculosis, but indeed, cultivating serial samples increases sensitivity.

Renal manifestations in children co-infected with HIV and disseminated tuberculosis.

Many children in Cape Town are co-infected with human immunodeficiency virus (HIV) and tuberculosis (TB). Granulomatous TB interstitial nephritis is a recognized entity. Our objective was to establish if TB plays a role in renal disease in HIV-infected children. We identified children co-infected with TB and HIV from our database and reviewed their biopsies and clinical notes. Since 2002, 12 renal biopsies or postmortem examinations were performed on HIV-infected children at our institution. The clinical scenario and renal biopsies in four cases (median age 73 months, range 24-108 months) were consistent with TB involvement. The mean CD4 count and percentage of these four patients were 508 cells/microl and 23%, respectively. All four patients presented with culture-proven disseminated TB (not yet on treatment) and had nephrotic range proteinuria and hypoalbuminemia. Three of these patients had renal impairment. The prominent features of the renal biopsies were a severe interstitial inflammatory infiltrate and mild to moderate mesangial proliferation. An interstitial granuloma was seen in one patient. With treatment for the TB, the proteinuria resolved and renal function improved in all four patients. Based on these results, we conclude that TB contributes to proteinuric renal disease in HIV-infected children and that the renal disease improves following TB treatment.

Renal and miliary tuberculosis in an internationally adopted infant.

Renal tuberculosis is rare in children and particularly in infants. We present a case of miliary tuberculosis with focal renal involvement in a 5-month-old male infant recently adopted from Ethiopia, and review the literature on miliary and renal tuberculosis in infants and children. Salient points regarding tuberculosis screening in internationally adopted patients are also addressed.

Tuberculosis of the renal artery: a rare cause of renovascular arterial hypertension.

Tuberculosis is an endemic disease in Morocco. Main blood vessels are rarely affected; the few mentioned cases are aneurysmal. We report a 17-year-old patient presenting with renovascular arterial hypertension, revealed thanks to the discovery of an occlusion of the right renal artery in Duplex scan. During the intervention, the observation of pararenal and mesenteric tuberculous polyadenopathy let us suggest the same kind of lesion at the level of the occluded renal artery. Once antituberculosis treatment had been carried out, the right renal artery was revascularized with a right iliorenal bypass using reversed internal saphenous vein. The postoperative course was uneventful, with an 18-month follow-up. Arterial pressure was normal without antihypertensive treatment, and the bypass was patent. As far as we know, this is the first case of renovascular arterial hypertension resulting from tuberculosis treated with an iliorenal bypass.

Superior virulence of Mycobacterium bovis over Mycobacterium tuberculosis (Mtb) for Mtb-resistant and Mtb-susceptible mice is manifest as an ability to cause extrapulmonary disease.

Mice of a Mycobacterium tuberculosis-resistant (BALB/c) and of a M. tuberculosis-susceptible (DBA/2) strain proved considerably more susceptible, and equally so, to infection with Mycobacterium bovis than with M. tuberculosis when infection was initiated via the iv route. Infection with M. tuberculosis was eventually controlled at an approximately stationary level in the lungs, livers, spleens and kidneys of BALB/c mice, and in all of these organs except the lungs in DBA/2 mice. M. tuberculosis-infected DBA/2 mice died with a much shorter median survival time (MST) than M. tuberculosis-infected BALB/c mice. By contrast, infection with M. bovis killed mice of both strains with the same and much shorter MST. Unexpectedly, M. bovis caused progressive infection and pathology in the livers of BALB/c mice, but not in this organ in DBA/2 mice. More importantly, this pathogen caused progressive infection and infection-induced pathology in the kidneys and adrenal glands of both strains of mice. It is proposed that disease of the adrenal glands might serve to explain why M. bovis caused mice of both strains to die with the same much shorter MST.

Ultrasonographic evaluation of renal infections.

Renal sonography can be easily performed and provides valuable information concerning the underlying disease process, helping to decide appropriate management. This article reviews the important renal infections, such as pyelonephritis, emphysematous pyelonephritis, renal abscess, hydatid disease, renal tuberculosis, pyonephrosis, and HIV-associated nephropathy.

[Current methods in diagnosis of the kidney tuberculosis].

Conventional and updated medical technologies of detecting M. tuberculosis (MT) and tuberculosis antibodies (TAB) were compared. It is shown that molecular-biological and immunological methods can be used only in rapid diagnosis and screening. They should be followed by further examinations as urine MT makers and blood TAB are not criteria for final diagnosis of renal tuberculosis. Routine microbiological methods are most precise in the above diagnosis. Diagnosis of initial forms of renal tuberculosis is still unsolved problem. Low professional skills of outpatient service urologists in the field of urogenital tuberculosis explain late detection of urinary tuberculosis.

[Capacities of rapid diagnostic methods in renal tuberculosis].

The paper comparatively assesses routine and new medical technologies (metachromatic urine test, polymerase chain reaction, chromatographic mass spectrometry, and enzyme immunoassay) for detection of Mycobacterium tuberculosis and tuberculosis antibodies. It is shown that molecular biological and immune assays may be used only for rapid diagnosis and screening, followed by a full-scale phthisiourological study as the detection of markers of Mycobacterium tuberculosis and tuberculosis antibodies cannot be a criterion for establishing renal tuberculosis. The authors consider that the conventional microbiological tests whose validity is beyond question in case of positive results are the most established and practice-tested canons of phthisiourological diagnosis.

[Isolation frequency of the Mycobacterium genus in urine samples]. / Frecuencia de aislamiento del género Mycobacterium en muestras de orina.

Kidney infections caused by Mycobacterium genus are torpid and chronic evolution. In this study were analyzed 177 urine samples (included 110 from HIV patients) received between January 2006 and July 2014 in the National Reference Laboratory of Tuberculosis at Tropical Medicine Institute "Pedro Kourí" (IPK). The results were 17 isolates Mycobacterium tuberculosis, and 30 isolates of nontuberculous mycobacteria were detected. This study confirms the diagnostic importance of these infections especially in HIV/AIDS patients.

Drug-resistant strains of Mycobacterium tuberculosis isolated in Russia.

SETTING: State Research Center for Applied Microbiology, Russian Research Institute of Phthisiopulmonology (Ministry of Health, Moscow). OBJECTIVE: To analyze drug-resistant clinical isolates of Mycobacterium tuberculosis obtained from patients referred to the institute from different parts of Russia, and to study the mechanisms of their rifampicin resistance. DESIGN: Fifty clinical isolates of M. tuberculosis were analysed. Polymerase chain reaction (PCR) and sequencing were used to study the mechanisms of rifampicin resistance in 25 isolates. RESULTS: Among cultures isolated from 50 patients, drug resistance was detected in 33. Most of the isolates were resistant to rifampicin (25 isolates), isoniazid (14 isolates), and streptomycin (seven isolates). Only 6% of the isolates were resistant to one drug, while 14% were resistant to two, 32% to three, 40% to four, and 8% to five drugs. Susceptible isolates were derived from 17 patients. The following point mutations and deletions in the rpoB locus, responsible for high level rifampicin resistance (more than 50 microg/ml in egg-based medium), were detected: G-->A/395 (Arg-->Gln), C-->T/232 (His-->Tyr), C-->T/221 (Ser-->Leu), G-->T/202 (Asp-->Tyr), GA-->TT/202-203 (Asp-->Phe), deltaATGGACCAG/199-207 (Met, Asp, Gin), A-->T/91 (Met-->Leu), TG-->CC/227-228 (Leu-->Ser), GAG-->AGT/349-350-351 (Gln-->Ser), deltaGGG/354(Gly). CONCLUSION: A number of previously unrecognised genetic modifications in the rpoB region were found in rifampicin-resistant strains isolated from patients from different parts of Russia.

Current concepts on pathogenesis of renal tuberculosis.

The pathogenesis of renal tuberculosis begins with the initial localization of the tubercle bacilli in the cortical glomeruli causing mechanical stress which lead to alteration in cell morphology, increased rate of protein synthesis and proliferation of resident glomerular cells as well as the infiltrating blood borne cells. The infection may remain localized to the renal parenchyma resulting in various forms of glomerulonephritides and/or gain access to the calyceal system causing pyelocalyceal destruction with subsequent ureteric and urinary bladder involvement. The disease may remain quiesent at the foregoing stage or progress to hydronephrosis and pyonephrosis as a result strictures and obstruction. This communication discusses the immunological responses and various specific lesions resulting from renal injury caused by mycobacterium tuberculosis.

[A case of renal tuberculosis following bacillus Calmette-Guerin instillation therapy for bladder cancer].

A rare case of histopathologically revealed renal tuberculosis caused by intravesical bacillus Calmette-Guerin (BCG) therapy is reported. A 67-year-old man was admitted complaining of fever and micturition pain. He had been undergoing prophylactic BCG instillation therapy for recurrent superficial bladder tumor. Physical examination was unremarkable. The tuberculin skin test was negative. Mycobacterium tuberculosis (MT) was not demonstrated by acid-fast staining and culture of urine. However, MT was isolated by the polymerase chain reaction method. In the following 7 days, symptoms were dissolved with administration of isoniazid, rifampicin and piperacillin. Two months later, nephroureterectomy was performed because of left renal pelvic tumor. Tuberculomas were also found in the renal parenchyma which showed no MT by Ziehl-Neelsen's method. Anti-tuberculous medication was not given postoperatively. Two months after operation, he is free of disease with normal urine examination and positive tuberculin skin test measuring 12 x 10 mm.