Tuberculous pyelonephritis in children: three case reports.

Tuberculous pyelonephritis is rare in children; three case reports are presented. Case 1 was an 11-year-old girl with a previous history of pulmonary tuberculosis who presented with flank pain and fever for 10 days. An ultrasound suggested focal pyelonephritis, and a contrast-enhanced computed tomography (CECT) scan demonstrated acute focal pyelonephritis and a perinephric collection. Mycobacterium tuberculosis was cultured in the urine. She responded well to anti-tuberculous treatment (ATT). Case 2 was a 13-year-old boy who presented with fever, haematuria, burning micturition, proteinuria (3+) and cervical lymphadenopathy. The Mantoux test was strongly positive. Chest radiograph demonstrated right hilar lymphadenopathy and ultrasonography showed evidence of acute pyelonephritis. Tuberculous lymphadenitis was diagnosed by fine-needle aspiration cytology (FNAC) from cervical lymph nodes and he responded to ATT. Follow-up urinalysis and ultrasound were normal. Case 3 was a 6-year-old boy, a known case of pulmonary tuberculosis (from 2 years of age) and a previous defaulter from ATT. He presented with symptoms of lumbar pain and dysuria. Chest radiograph demonstrated mediastinal lymphadenopathy and a CECT of the head showed a tuberculous granuloma. CECT of the abdomen showed an enlarged left kidney with focal pyelonephritis, an abscess in the upper pole and parenchymal calcification. FNAC of the cervical lymph nodes supported a diagnosis of disseminated tuberculosis with tuberculous pyelonephritis. He was given 8 months of ATT. Fifteen months later he presented again with clinical and urinary findings of urinary tract infection. CECT now demonstrated gross hydronephrosis of the left kidney, and it was confirmed to be non-functioning by a DMSA scan and magnetic resonance urogram. Diethylenetriaminepentaacetic acid showed a GFR of 44.3 ml/min/1.73 m2. Nephrectomy was undertaken and the histology confirmed tuberculous pyelonephritis. Six months later he was well with an eGFR of 87.2 ml/min/m2. In patients with symptoms of urinary tract infection but sterile urine who do not respond to antibiotics or have evidence of tuberculous elsewhere in the body, careful consideration should be given to the possibility of tuberculous pyelonephritis.

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 allograft tuberculosis with infected lymphocele transmitted from the donor.

Transmission of tuberculosis (TB) from a donor through renal transplantation is a rare incident. We are reporting a 53-year-old Qatari woman diagnosed with renal allograft TB infection. The disease was confirmed by isolation of Mycobacterium tuberculosis from fluid from the lymphocele and demonstration of caseating granuloma in graft biopsy with acid-fast bacilli seen on Ziehl-Neelsen staining. The diagnosis was made quite early post-transplantation. The presence of the granuloma, which is unusual with patients on intensive immunosuppressant medications, suggests that transmission of the infection occurred from the donor rather than from the activation of latent infection. In reviewing the literature, we found ten case reports of TB in transplanted kidney with transmission of TB infection from the donor. The presence of TB in lymphocele in association with the infected transplant by TB, to the best of our knowledge, was reported only once in the literature. Our case had unfavorable outcome and ended by renal allograft nephrectomy and hemodialysis. We are presenting this case of TB infection of renal allograft and lymphocele diagnosed early post-transplantation transmitted from the donor and pertinent review from the literature.

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.

[Role of supravesicular urine diversion in the treatment of patients with renal and urethral tuberculosis].

The article presents the results of the survey, etiopathogenetic and surgery treatment of 73 patients with nephrotuberculosis complicated by tuberculous ureteritis. Patients were divided into 4 groups. 1-3 Groups of patients underwent urine diversion by percutaneous puncture nephrostomy, open nephrostomy and internal stent placement. Patients in Group 4 not underwent surgery with urine diversion. It was found that the long-term etiopathogenetic therapy against the background of retention changes resulted in progression of changes and loss of renal function in 63% of cases. Early urine diversion, depending on its method allows preserving the functional ability of the kidneys in 70.8 to 94.4% of cases. The combination of early renal drainage with antituberculous polychemotherapy is significantly superior to conservative treatment, leads to a rapid reduction of chronic renal failure (CRF) and allows to subsequently perform the greatest number of reconstructive operations: in 62.6% of cases after the external drainage and in 73.3%--after internal drainage (p < 0.05). At the same time, good results of plastics were achieved only in patients undergoing a two-stage surgical treatment, and poor results (relapse of stricture, progression of hydroureteronephrosis or CRF) were significantly more often observed (60%) in patients without urine diversion (p < 0.05).

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.

Granulomatous interstitial nephritis due to tuberculosis-a rare presentation.

Granulomatous interstitial nephritis (GIN) is an uncommon form of acute interstitial nephritis. We report a young male who presented to us with a rapidly progressing renal failure and massive proteinuria. A renal biopsy revealed GIN, and we were able to demonstrate the presence of tuberculous DNA in the biopsy specimen. The patient was started on anti-tuberculous therapy and steroids besides 11 sessions of hemodialysis. He recovered and is currently doing well. This case highlights an uncommon manifestation of renal tuberculosis, namely massive proteinuria, acute renal failure, and granulomatous interstitial lesions.

Renal tuberculosis simulating xanthogranulomatous pyelonephritis with contagious hepatic involvement.

Xanthogranulomatous pyelonephritis (XGPN) is a chronic renal infection typically associated with nephrolithiasis and a non-functioning kidney. Renal tuberculosis is a major cause of morbidity in developing countries. Despite recent advances in diagnosis, it is sometimes difficult to differentiate renal tuberculosis preoperatively from XGPN. We present herewith a case report of a patient who was preoperatively diagnosed with a right non-functioning kidney due to renal calculus with stage 3 XGPN and adjacent liver abscess on computed tomography. Subsequent histopathological examination of the nephrectomised specimen revealed renal tuberculosis. To our knowledge this is the first case of renal tuberculosis spreading to the liver and causing liver abscess formation which was misdiagnosed as XGPN preoperatively.

Urinary tuberculosis: ten years' experience.

In this study of 26 patients, clinical features diagnosed as urinary tuberculosis in our nephrology and urology clinics between 1993 and 2002 were investigated retrospectively. Fifteen patients (52%) were male, and mean age was 43.5 (18-71). Twenty percent of the patients were asymptomatic. Frequency-dysuria (46%), flank pain (33%), and macroscopic hematuria (12%) were presenting symptoms. Physical examination was not diagnostically helpful in most patients. Hematuria and/or pyuria were detected in 80% of the patients. Eleven patients had positive urine cultures of Mycobacterium tuberculosis (42%), and 7 patients had positive smears (25%). Definitive diagnosis of urinary tuberculosis was established microbiologically in 15 patients (58%) and histopathologically in 11 patients (42%). Tuberculin skin test was positive in 60% of the patients. Eight patients had an abnormal chest roentgenogram. Hydronephrosis (majority bilateral) in 11 patients (42%), contracted bladder in 9 patients (34.6%), and renal calcification in 6 patients (23%) were detected. Two patients also had genital tuberculosis (epididymoorchitis). Although only medical treatment was applied in 13 patients for 9 months, in the rest of the patients medical therapy plus surgical intervention was carried out. End-stage renal failure developed in one patient who died on hemodialysis. Renal functions had decreased moderately in two other patients. In conclusion, the diagnosis of urinary tuberculosis was able to be established after the obstructive complications and functional losses were developed in a fair number of cases. Surgical treatment was carried out in half the patients. Urinary tuberculosis should be taken into consideration because early diagnosis and treatment is very important for the presenting of irreversible sequelae.

Imaging of renal tuberculosis in eastern Taiwan: correlation with clinical course and different communities.

Hualien, located in eastern Taiwan, is a relatively isolated district. The population is composed of different ethnic communities. Our hospital is the only medical center in eastern Taiwan, so is the most important referral hospital for epidemic diseases. After reviewing our collected cases of renal tuberculosis (TB), we observed a great diversity in staging and outcomes. The aim of this study was to classify different imaging presentations and clinical outcomes in the ethnic communities represented by these cases (non-aboriginal and aboriginal). We retrospectively reviewed 22 cases from 1991 to 2001. We reviewed laboratory data, radiologic reports, and clinical outcomes. Before TB was proved by biopsy or culture, patients were not treated with an anti-TB regimen. Roentgenography showed that 68% of patients had renal calcification, 59% had dilated calyces, 55% had lung involvement, and 41% had auto-nephrectomy. The proportion of mild and severe forms was significantly different between aboriginal and non-aboriginal groups (0.05 > p > or = 0.00409). From this series, we recommend routine plain film roentgenography, including chest roentgenography and kidney, ureter, and bladder or abdominal roentgenography, followed by intravenous urography or computerized tomography as investigative tools for renal TB. Based on the significantly different outcomes of the disease between aboriginal and non-aboriginal groups, a stronger health education program for the isolated district in eastern Taiwan is necessary.

[Characteristics on diagnosis and treatment of renal tuberculosis].

OBJECTIVE: To study the new characteristics on diagnosis and treatment of renal tuberculosis (RT). METHODS: Eighty-seven patients with renal tuberculosis were retrospectively reviewed; their diagnosis was established by standard microbiological and histological techniques. RESULTS: Atypical RT was diagnosed by various examinations, including urinary analysis, polymerase chain reaction of tuberculosis (PCR-TB), ultrasonography, intravenous urography (i.v.U), and computerized tomography (CT). Treatment consisted of antituberculous chemotherapy in all patients, in combination with nephrectomy (62.5%) or enterocystoplasty (4.6%). CONCLUSIONS: The differential diagnosis of RT should be emphasized, especially for atypical RT, provided a much more specific diagnosis in clinical suspicion of RT. i.v.U can not be regarded as a specific examination for RT. Computerised tomography (CT) can be used for early diagnosis of RT. Surgery for RT is still ablative.

[Polychemotherapy combined with low-intensity laser therapy in treating patients with renal tuberculosis]. / Polikhimioterapiia v sochetanii s nizkointensivnoi lazernoi terapiei v lechenii bol'nykh nefrotuberkulezom.

A prospective study of 150 patients with verified nephrotuberculosis has demonstrated feasibility of essential expansion of the therapeutic limit and of 1/3 reduction in the number of operations due to adjuvant radiation with low-intensity laser beam used in a complex of etiopathogenetic treatment of the urinary system.

Role of early endourologic management of tuberculous ureteral strictures.

BACKGROUND AND PURPOSE: Tuberculous ureteral stricture causing progressive obstructive uropathy commonly complicates renal tuberculosis. The aim of our study was to evaluate the effectiveness of early ureteral stenting or percutaneous nephrostomy (PCN) in patients with tuberculous ureteral strictures. PATIENTS AND METHODS: Seventy-seven patients (84 renal units) with tuberculous ureteral strictures were analyzed. We evaluated the final outcome of involved kidneys with three different managements: medication only (N = 37), medication plus ureteral stenting (N = 28), or medication plus PCN (N = 19). RESULTS: The overall nephrectomy rate was 51%. In patients treated with medication only, the nephrectomy rate was 73%, whereas the nephrectomy rate was 34% in patients treated with medication plus early ureteral stenting or PCN. The rate of reconstructive surgery for ureteral strictures also was significantly different for patients treated with medication only (8%) and those receiving medication plus early ureteral stenting or PCN (49%). Spontaneous resolution of the strictures was noted in 6 of the 12 renal units that were managed with early ureteral stenting. CONCLUSIONS: Early ureteral stenting or PCN in patients with tuberculous ureteral strictures may increase the opportunity for later reconstructive surgery and decrease the likelihood of renal loss.

Tuberculosis en el Hospital Militar "Dr. Carlos Arvelo" 1985-1995 / Tuberculosis in the Hospital Militar \"Dr. Carlos Arvelo\" 1985-1995

Se seleccionaron 126 casos de TBC pulmonar y extrapulmonar diagnosticados y tratados en los Servicios de Medicina Interna y Neumonología, se analizaron por grupo etario, sexo, filiación procedencia motivo de consulta, bacilíferos negativos y positivos, PPD, velocidad de sedimentación globular, esquema de tratamiento aplicado, resistencia al tratamiento y enfermedades asociadas. La edad más afectada fue entre los 15 y 24 años (48,4 por ciento), predominó el sexo masculino 76,9 por ciento. La incidencia según filiación fue mayor en el personal militar 61,1 por ciento que en los no militares 27,7 por ciento y no afiliados 11,1 por ciento. La procedencia predominante fue el Distrito Federal 45.2 por ciento, seguido del Estado Miranda 9.5 por ciento. El motivo de consulta más frecuente fue síntomas de origen respiratorio 64.3 por ciento, seguido de pérdida involuntaria de peso 15.9 por ciento. La localización más frecuente de la infección por TBC fue la pulmonar 81.7 por ciento, sobre la extrapulmonar 18.3 por ciento. la baciloscopia positiva correspondió al 30.9 por ciento y la negativa al 50.8 por ciento. El PPD se aplicó en el 53.9 por ciento resultando positivo en 34.9 por ciento dudoso en 11.1 por ciento y negativo en 7.9 por ciento. La velocidad de segmentación globular fue elevada en el 87.3 por ciento con valor de 50 a 99 mm en el 45.2 por ciento. El esquema de tratamiento aplicado para la totalidad de los pacientes fue el parcialmente supervisado con 4 drogas (estreptomicina isoniacida, rifampicina y pirazimida), con un porcentaje de curación de 99.8 por ciento y sólo 2 casos de resistencia. En cuanto a las enfermedades asociadas predomino la diabetes en 4.7 por ciento, varicela 3.9 por ciento, seguidos de carcinomas 2.4 por ciento. La incidencia global por año predominó en 1990 con 21.4 por ciento y en 1991 con 11.9 por ciento