Paralytic Ileus during Treatment of Pulmonary and Renal Tuberculosis in a Non-Human Immunodeficiency Virus Patient: An Unusual Presentation of Tuberculosis-immune Reconstitution Inflammatory Syndrome.

Paralytic ileus as tuberculosis-immune reconstitution inflammatory syndrome (TB-IRIS) is extremely rare. We herein report a 44-year-old man with pulmonary and renal tuberculosis who developed paralytic ileus 14 days after starting antituberculosis therapy (ATT) despite an initial favorable response to ATT. Paralytic ileus was successfully managed with conservative care. He initially required hemodialysis because of obstructive uropathy due to renal tuberculosis, but he was able to withdraw from dialysis after placement of ureteral stents. TB-IRIS can affect organs other than the original sites of tuberculosis, and the combined use of steroids may be effective for its prevention and treatment.

Solitary tubercular renal cyst in a postpartum lady masquerading as an infected giant renal cyst with urosepsis.

Renal tuberculosis presenting as renal cyst is rare. Diagnosing renal tuberculosis in pregnancy is usually delayed due to its atypical presentation. We present a 28-year-old postpartum lady who delivered a healthy baby one month back, with history of intermittent fever and chills. She had high spiking fever (102° F), tachycardia (130/min) and computed tomography showed a 16 × 10 cm right renal cyst. Percutaneous drainage was done, 2 litres of thick pus drained and culture was sterile. After three weeks, deroofing and marsupialization of cyst was done. Biopsy revealed granulomatous inflammation composed of epitheliod histiocytes with central incipient necrosis suggestive of tuberculosis. She was treated with anti-tubercular drugs. As the infant was healthy and had no evidence of tuberculosis, no treatment was initiated. The mother is on follow up for 2 years. This case highlights the rare presentation of renal tuberculosis in puerperium.

[Colorenal fistula complicating renal tuberculosis: a case report]. / Fistule réno-colique compliquant une tuberculose rénale: à propos d'un cas.

Urogenital tuberculosis is little suspected and known by clinicians. Colorenal fistulas, although rare, are complex forms of renal tuberculosis occurring in patients with advanced-stage disease. They generally occur in the ascending and descending colon. We here report the clinical case of a 58-year-old female patient presenting to the Emergency Department with severe acute left pyelonephritis. Abdominal CT scan objectified left pyonephrosis with left colorenal fistula. The patient had poor clinical, biological outcome despite resuscitation measures and antibiotic treatments. Urgent left nephrectomy was performed with disconnection and drainage of colorenal fistula. Histology showed renal tuberculosis. The patient received antibacillary drugs according to 2ERHZ/4RH guidelines. The treatment of this type of TB should be adequate to avoid recurrences that could be more complicated to manage.

[Surgical treatment of patients with renal tuberculosis, complicated by ureteral tuberculosis].

INTRODUCTION: Late diagnosis of renal tuberculosis leads to complications that cannot be eliminated by treatment. CLINICAL CASE: A clinical observation of patient Ch., born in 1976, who was admitted to TB Research Institute of Ministry of Health of Russia on 17.02.2020. A diagnosis was cavernous renal tuberculosis. Tuberculosis of the ureter. MBT (-). Right ureteral stricture (obliteration), complicated by ipsilateral hydronephrosis. Right nephrostomy tube (2018). Clinical cure of disseminated pulmonary tuberculosis. He underwent planned laparoscopic bowel substitution of the right ureter on 10.03.2020. In the postoperative period, pyelonephritis developed, which was resolved by drug therapy. CONCLUSION: In this case, there is the correct tactics of outpatient urologists. When hydronephrosis was diagnosed, a nephrostomy tube was put, which allowed to preserve the kidney, Then the patient was immediately referred to a phthisiatrician to exclude urogenital tuberculosis. In the local TB dispensary, the patient did not have the opportunity to receive necessary treatment, and he was transferred to the TB Research Institute of Ministry of Health of Russia, where a reconstructive laparoscopic procedure was performed.

[Surgical treatment of patients with renal tuberculosis, complicated by ureteral tuberculosis].

Late diagnosis of renal tuberculosis leads to complications that cannot be eliminated by treatment. A clinical observation of renal tuberculosis, complicated by total ureteral obliteration, in a comorbid patient is presented. He underwent planned bowel substitution of the right ureter. In the postoperative period, pyelonephritis developed, which was resolved by drug therapy. In this case, there is the correct tactics of outpatient urologists. When hydronephrosis was diagnosed, a nephrostomy tube was put, which allowed to preserve the kidney, Then the patient was immediately referred to a phthisiatrician to exclude urogenital tuberculosis. In the local TB dispensary, the patient did not have the opportunity to receive necessary treatment, and he was transferred to the TB Research Institute of Ministry of Health of Russia, where a reconstructive laparoscopic procedure was performed.

[Renal tuberculosis disease indicative of Pott's disease]. / Une atteinte tuberculeuse rénale révélatrice d'un mal de Pott.

Tuberculosisis is a serious desease, causing high morbidity and mortality. It includes frequent extra-pulmonary forms, polymorphic in their clinico-radiological presentation, resultsing in a delayed diagnosis. We report the case of a rare association of renal tuberculosis and Pott's disease. It is the case of a 19-year-old patient. He has two brothers on chronic hemodialysis. He is hospitalized for exploration of a lumbar mass and a cachectic state. Radiological imaging (MRI, scanner) suggests osteosarcoma. The renal biopsy, performed for the nephrotic syndrome, reveals the presence of a granulomatous interstitial infiltration, which suggests a tuberculosis. The anatomo-pathological study, of the excisional piece of the lumbar mass, confirms the diagnosis of tuberculous spondylodiscitis. The clinico-biological evolution, with four antituberculous therapy is favorable, except for the persistence of the glomerular syndrome.

An adolescent girl with obstructive uropathy requiring nephro-ureterectomy was subsequently diagnosed with renal tuberculosis: case report.

A 15-year-old girl was followed up for 2 years in a district hospital for management of vesicoureteral reflux and, subsequently, hydronephrosis of both kidneys and required bilateral ureteroneocystostomy. Despite surgery, there was continuous progression of the left hydronephrosis. Referral to a tertiary hospital because of continued sterile pyuria prompted investigation for tuberculosis (TB): she was diagnosed with bilateral pulmonary TB and urine culture confirmed Mycobacterium tuberculosis. Despite tuberculous chemotherapy and dexamethasone, she required a left nephrectomy. Histology demonstrated necrotising granulomatous pyelonephritis. She remains well with normal function of the right kidney. Despite the rarity, chronic urinary tract disorders should always prompt investigation for tuberculosis.

Curious case of fever of unknown origin.

A 58-year-old immunocompetent woman presented with fever and significant weight loss of 4-month duration. She had mild pallor; rest of the examination was unremarkable. Investigations revealed anaemia with raised inflammatory markers. Cultures, serologies, routine urine examination, bone marrow examination, contrast enhanced CT and two-dimensional echocardiography examination were unremarkable. An 18F-fluorodeoxyglucose positron emission tomography with CT (18F-FDG-PET/CT) scan was performed which revealed atypical heterogenous uptake in bilateral renal cortex. Subsequently, urine GeneXpert came positive for Mycobacterium tuberculosis with sensitivity to rifampicin. She responded to category 1 antitubercular therapy. The challenges in diagnosis of genitourinary tuberculosis, low sensitivity of conventional diagnostic tests and potential role of GeneXpert and 18F-FDG-PET/CT scan are discussed in this report.

Two unusual reports of urogenital tuberculosis: One 'putty' kidney and another in association with benign prostatic hyperplasia.

In India urogenital tuberculosis is the second commonest form of extra-pulmonary tuberculosis. Kidney is the highest and prostate is the least affected urogenital organ. But the extreme stage of renal tuberculosis named as 'putty' kidney is a rare manifestation. In general most cases of urogenital tuberculosis are quasi-symptomatic, and therefore an uttermost apprehension is needed from physicians to intercept such cases at the earliest. In this presentation we describe a case of 'putty' kidney, and another incidental association of prostate tuberculosis with benign prostatic hyperplasia.

Early Diagnosis of Tuberculosis-Associated IgA Nephropathy with ESAT-6.

IgA nephropathy (IgAN) is the most common cause of primary renal diseases worldwide, and the early secreted antigenic target of 6 (ESAT-6) which was secreted by Mycobacterium tuberculosis (MTB) may be involved in the development and progression of IgAN. This study aimed to investigate the role of ESAT-6 for early diagnosis of IgAN caused by MTB infection. From 2011 to 2014, 21 patients with renal tuberculosis (RTB), 25 with IgAN, and 46 with IgAN infected with MTB (IgAN/MTB) were enrolled. Serum levels of antibodies against Mycobacterium tuberculosis antigen 85A (Ag85A) were measured by ELISA. Urine culture and phage amplified biologically assay were performed to detect MTB. HE staining was used to observe the morphological changes in kidney tissues. Immunohistochemistry was applied to detect the expression of ESAT-6. Immunofluorescence staining was conducted to detect IgA1. Positive rates of serum anti-Ag85A antibody and urine culture for MTB were higher in the RTB and IgAN/MTB groups than those in the IgAN group. The positive rates of plaques were also higher in RTB and IgAN/MTB groups than the positive rate in the IgAN group. By contrast, the positive rate of ESAT-6 was lower in the IgAN group than that in the RTB group or the IgAN/MTB group, whereas the expression levels of IgA1 were higher in the IgAN and IgAN/MTB groups, compared with the RTB group. Our findings suggest that ESAT-6 and IgA1 may be helpful for early diagnosis of IgAN caused by MTB infection.

Clinical Features and Drug-Resistance Profile of Urinary Tuberculosis in South-Western China: A Cross-sectional Study.

To investigate the epidemiology, clinical features, and drug-resistance profile of urinary tuberculosis (UTB) in south-western China to improve UTB diagnostics.After the screening of 1036 cases of suspected UTB, 193 patients with UTB were enrolled during 2009 to 2014. Urine samples were collected for routine urinalysis, smear, tuberculosis DNA (TB-DNA) detection, and drug-resistant analysis, whereas blood samples were collected for erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and renal function evaluation. Clinical features (such as symptoms and outcome) and imageology results (such as B ultrasonic, computerized tomography, intravenous pyelography, and renography) were also collected and analyzed to investigate the epidemiology, clinical features, and drug-resistance profile.The most common presenting symptoms were urinary irritation (61.1%) and lumbago (49.2%). High proportions of microscopic hematuria (63.2%) and microscopic proteinuria (45.6%) were also observed. The positive rate for TB-DNA was 66.3%. The positive rate for culture was 13.1% and for smear it was 9.8%. The abnormal outcome rates of the computerized tomography, ultrasonography, intravenous pyelography, and the nephrogram were 76.9%, 70.1%, 29.8%, and 37.0%, respectively. The total rate of drug-resistant TB (resistant to at least 1 drug) was 39.7%, of which 20.7% was multidrug-resistance TB. The most prevalent mutation sites were katG S315T1, rpoB S531L, and gyrA D94G.We observed a serious epidemic of drug-resistant UTB and a substantial number of new UTB cases with multidrug resistance TB. Molecular diagnostics is crucial in the definite diagnosis of UTB, and our finding is a supplement and further confirmation of polymerase chain reaction usage for TB diagnosis. We recommend real-time polymerase chain reaction for TB-DNA identification instead of culture, and GenoType tests (MTBDRplus and MTBDRsl assay) for drug resistance as routine assays for patients with suspected UTB.

Tuberculosis en receptores de trasplante renal: experiencia en una unidad de trasplante renal de Perú / Tuberculosis in renal transplant recipients: experience in a kidney transplant unit in Peru

Introducción: El trasplante de órganos conlleva riesgo de contraer tuberculosis (TB) a resultas de la necesaria inmunosupresión concurrente. La literatura señala una incidencia de 0,35 por ciento a 15 por ciento. En nuestro medio, carecemos de datos al respecto. Objetivos: Explorar la epidemiolog¡a, cuadro clinico y pronóstico de la TB en receptores de trasplante renal en  rea endémica. Igualmente, efectuar el analisis de casos multidrogorresistentes (MDR). Diseño: Estudio retrospectivo. Institución: Departamento de Nefrologia, Hospital Edgardo Rebagliati Martins, EsSalud, Lima, Perú. Material: Historias clinicas de casos de trasplante renal comprendidos en el periodo 1999-2014. Intervenciones: Se revisó en 619 casos de trasplante renal la instalación de tuberculosis, as¡ como se efectuó el analisis de casos multidrogorresistentes. Principales medidas de resultados: Instalación de tuberculosis y casos multidrogorresistentes. Resultados: La TB se instaló en 22 pacientes (3,5 por ciento), incidencia mayor que la obtenida en la población general del pais (96/100 000/anual). La fiebre (57 por ciento) y la tos crónica (28 por ciento) fueron los sintomas m s comunes. La TB extrapulmonar (50 por ciento) predominó sobre la pulmonar (40 por ciento) y la diseminada (10 por ciento). La ocurrencia de TB fue mayoritariamente después del año (72 por ciento). Siete de los casos (28 por ciento) cursaron con creatinina mayor de 2 mg porcentaje al momento del diagnóstico y tres de ellos retornaron a dialisis. Hubo cuatro casos de TB MDR. Conclusiones: El diagnóstico temprano en base a la sospecha clinica de TB y el tratamiento oportuno mejora el pronóstico en esta población.

Introduction: Organ transplantation carries a risk of contracting tuberculosis (TB) due to the required concurrent immunosuppression. Literature reports an incidence of 0.35 per cent-15 per cent. There is no data on this matter in our region. Objectives: To determine epidemiology, clinical findings and prognosis of TB in renal transplantation recipients in an endemic area. The study also aimed to analyze multidrug-resistant (MDR) cases. Design: Retrospective study. Setting: Department of Nephrology, Hospital Edgardo Rebagliati Martins, EsSalud, Lima, Peru. Material: Clinical charts of renal transplant patients attended during 1999-2014. Interventions: Onset of tuberculosis was determined in 619 cases of renal transplant, as well as analysis of multidrug-resistant cases. Main outcome measures. Installation of tuberculosis and cases of multidrug resistance. Results: TB developed in 22 patients (3.5 per cent), more prevalent that the country general population (96/100 000/year). Fever (57 per cent) and chronic cough (28 per cent) were the most common symptoms. Extrapulmonary TB (50 per cent) predominated over pulmonary (40 per cent) and disseminated TB (10 per cent). TB occurred usually after one year (72 per cent) and on average within the 41st month post transplantation. Seven cases (28 per cent) presented creatinine above 2 mg percentage at diagnosis and three of them returned to dialysis. There were four cases of MDR TB. Conclusions: Early diagnosis based on TB clinical suspicion and timely treatment improves the prognosis in this population of immunosuppressed patients.

[The Great Imitator. Case report]. / A nagy imitátor.

Authors present two patients suffering from renal tuberculosis, which caused differential diagnostic problems. The first patient was examined because of fever and left flank pain. Computed tomography revealed renal shrinkage on the left side. Retrograde pyelography demonstrated ureteric stricture and dilated calices. Urine culture showed Mycobacterium tuberculosis. Two months after initiation of the antituberculotic therapy nephrectomy was performed. The second patient was referred to the department because of fever after unsuccessful antibiotic treatment. Ultrasound examination showed a staghorn stone, dilated renal pelvis and perirenal abscess on the left side. Double J catheter insertion and percutaneous puncture of the abscess were performed. Culture of the pus aspirated proved Proteus morganii. Fever and complaints of the patient relieved after antibiotic treatment. Two months later double J catheter was changed because of persistent pyelonephritis. One week later the patient returned to the hospital with fever, which could not be reduced with intravenous antibiotics. Computed tomography showed purulent fluid in the left kidney, and nephrectomy was performed. Histology revealed renal tuberculosis. The authors summarize the diagnosis and treatment of renal tuberculosis on the basis of these two cases.

Urinary tuberculosis: a cohort of 79 adult cases.

We aimed to investigate the demographic, clinical, diagnostic, treatment and outcome features of patients with urinary tuberculosis (UTB). Patients with UTB admitted to seven separate centers across Turkey between 1995 and 2013 were retrospectively evaluated. The diagnosis of UTB was made by the presence of any clinical finding plus positivity of one of the following: (1) acid-fast bacilli (AFB) in urine, (2) isolation of Mycobacterium tuberculosis, (3) polymerase chain reaction (PCR) for M. tuberculosis, (4) histopathological evidence for TB. Seventy-nine patients (49.36% male, mean age 50.1 ± 17.4 years) were included. Mean time between onset of symptoms and clinical diagnosis was 9.7 ± 8.9 months. The most common signs and symptoms were hematuria (79.7%), sterile pyuria (67.1%), dysuria (51.9%), weakness (51.9%), fever (43%) and costovertebral tenderness (38%). Cystoscopy was performed in 59 (74.6%), bladder biopsy in 18 (22.8%), kidney biopsy in 1 (1.26%) and nephrectomy in 12 (15.2%) patients. Histopathological verification of UTB was achieved in 12 (63.1%) patients who undergone biopsy and in 100% of those undergone nephrectomy. Mycobacterium tuberculosis was isolated in the urine of 50 (63.3%) cases. Four-drug standard anti-TB treatment was the preferred regimen for 87.3% of the patients. Mean treatment duration was 10.5 ± 2.7 months. Deterioration of renal function occurred in 15 (18.9%) patients two of whom progressed to end-stage renal disease and received hemodialysis. Only one patient died after 74-day medical treatment period. Cases with UTB may present with non-specific clinical features. All diagnostic studies including radiology, cyctoscopy and histopathology are of great importance to exclude UTB and prevent renal failure.

Renal tuberculosis: a case report.

Tuberculosis or TB (tubercle bacillus) remains a major public health problem in developing countries. Over the last decades extrapulmonary locations of the disease have become more frequent due to the increased prevalence of acquired immune deficiency syndrome and the increase number of organ transplants. The urogenital localization represents about 27% of all extra-pulmonary localizations of TB and may be due either to a disseminated infection or to a primitive genitourinary localization. The majority of patients, has pyuria, sometimes with hematuria. The diagnosis of urinary tuberculosis is based on the finding of pyuria in the absence of infection by common bacteria. The initial medical treatment includes isoniazide, rifampicin, pyrazinamide, ethambutol and streptomycin. This disease should be suspected in patients with unexplained urinary tract infections, especially if immunocompromised and/or coming from endemic areas.

[Fanconi syndrome in a 22-year-old African patient]. / Syndrome de Fanconi chez un patient de 22 ans d'origine africaine.

Acquired Fanconi syndrome can occur in patients with monoclonal gammopathy or after exposure to heavy metals or drug agents such as ifosfamide, and some antiretroviral therapies. Fanconi syndrome is characterized by a dysfunctional of the proximal tubular responsible in its complete form for polyuria, hypokalemia, glycosuria, hypophosphatemia and low molecular weight proteinuria. We report the case of a 22-year-old patient hospitalized with an acute renal failure secondary to a tubulo-interstitial nephritis associated with a complete Fanconi syndrome in a context of a poor general condition and fever. We described and analyzed the process leading to the diagnosis.

[Surgical treatment of tuberculosis of the kidney with a total lesion of the ureter].

The study was aimed to improve the efficiency of surgical treatment of renal tuberculosis with total lesion of the ureter. The clinical course and the results of surgical treatment of 104 patients with extended or multiple ureteral strictures of specific (n=92) and non-specific (n=12) etiology. Thirty-five patients with nephrotuberculosis underwent percutaneous needle-guided nephrostomy (PNGNS), 79 underwent surgery with removal of organs: open nephrectomy with lumbar access (48), combined nephroureterectomy (31). According to the evaluation the glomerular filtration rate after PNGNS, value less than 10 ml/min led to performing nephrectomy, more than 10 ml/min - ureteroplasty. It was established that combined nephroureterectomy has significant advantages in the case of specific kidney disease, despite a long duration as compared with a nephrectomy. Removal of the kidney with ureter in patient with nephrotuberculosis is the prevention of persistent dysuria, empyema of ureter stump, its possible malignant transformation, and contributes to significant improvement of quality of life of the patient. Of the 35 patients after CHPNS, 25 underwent intestinoplasty of ureter: ileum was used in 23 patients, appendix- in 2 patients. It is shown that reconstructive surgery using small intestine allows to release 92% of patients from a lifetime external drainage of the kidney.