Enhancing Efficacy and Safety in Laparoscopic Partial Nephrectomy for Localized Renal Tuberculosis: The Skirted Continuous Suture Technique.

BACKGROUND Limited research has been conducted on laparoscopic partial nephrectomy for kidney tuberculosis. This study aimed to evaluate the effectiveness of the skirted continuous suture technique in laparoscopic partial nephrectomy for localized renal tuberculosis. MATERIAL AND METHODS Five patients with kidney tuberculosis underwent standard retroperitoneal laparoscopic partial nephrectomy after computed tomography evaluation. The skirted continuous suture technique was utilized during the procedure. This retrospective study analyzed the outcomes of these patients who received treatment between January 2011 and December 2020 at Beijing Tsinghua Changgung Hospital and Eighth Medical Center of Chinese People's Liberation Army General Hospital. RESULTS The surgical success rate was 100%. Renal function was well preserved, with a decrease of glomerular filtration rate by 9.6±9.0 ml/min. Only 1 patient experienced postoperative urinous infiltration and lymphatic fistula, while the others did not have any surgical complications. Antituberculous therapy was continued postoperatively, and 1 patient had recurrence during follow-up. CONCLUSIONS The laparoscopic continuous suturing technique offers a reliable and straightforward method for extensively closing incision edges of the renal parenchyma in laparoscopic surgery. It contributes to the improved efficacy and safety of treating localized renal tuberculosis with exceptional application.

[Renal tuberculosis in an isthmus of a horseshoe kidney after bacillus Calmette-Guerin therapy for bladder cancer].

A 63-year-old man with a horse shoe kidney was evaluated after an episode of asymptomatic gross hematuria. Cystoscopy revealed bladder tumor near the right ureteral orifice, and transurethral resection demonstrated high grade pT1 urothelial carcinoma. The patient was started on intravesical BCG instillation therapy at a dose of 81 mg weekly for 8 weeks without fever. 6 months later after the final BCG treatment, CT examination demonstrated a renal hypovascular tumor in an isthmus of a horseshoe kidney. We couldn't deny malignant tumor and tumorectomy was performed. Histological examination revealed epithelioid cell granulomas and no organisms were identified by Ziehl-Neelsen or Grocott-Gomori stains for acid-fast bacilli and fungi. We reported a rare case of renal tuberculosis in an isthmus of a horseshoe kidney after BCG therapy for bladder cancer that was considered due to vesicoureteral reflux.

[Chronic renal failure: unexpected late sequela of pulmonary tuberculosis after 30 years]. / Kronik Böbrek Yetmezligi: Pulmoner Tüberkülozun 30 Yil Sonra Gelen Beklenmeyen Geç Sekeli.

Tuberculosis-related chronic granulomatous tubulointerstitial nephritis (GTN) and chronic renal dysfunction as a consequence of GTN is a rarely seen clinical condition, with a few case reports in the literature. In this report, a case with end stage renal failure as an unexpected late extrapulmonary sequela of tuberculosis has been presented. A 60 years old female patient was admitted to hospital with the complaints of fever, malaise and nausea. Her history revealed that she had pulmonary tuberculosis 30 years ago and received antituberculosis therapy for nine months. The laboratory results on admission were as follows: blood urea nitrogen 90 mg/dl, serum creatinine 9 mg/dl, sodium 116 mEq/L, potassium 6.6 mEq/L, albumine 2.9 g/dl, hemoglobin, 8.4 g/dl, white blood cell count 10.800/mm3, C-reactive protein 187 mg/L and erythrocyte sedimentation rate 110 mm/hour. Urinalysis showed 8.1 g/L protein, 10-12 leukocytes, 1-2 erythrocytes, while 24-hours urinalysis yielded proteinuria with 8 ml/minutes creatinine clearance value. Urine and blood cultures of the patient revealed neither bacteria or mycobacteria. PPD skin test was negative. Acid-resistant bacilli (ARB) were not detected in sequential urine samples obtained on three consecutive days. Since sputum samples could not be obtained, diagnostic procedures for sputum were not performed. Abdomen ultrasonography yielded bilateral edema and grade II echogenity in kidneys. Computed tomography of the chest showed bilateral pulmonary nodules, chronic sequela lesions, pleural scarring and calcifications, as well as minimal interstitial infiltrate. Transthoracic lung biopsy showed chronic inflammation and fibrosis, while amyloid was negative. Renal biopsy showed GTN with central caseified necrosis and granulomas, multinuclear giant cells, tubular atrophy and interstitial fibrosis. Amyloid was negative and ARB were not detected in renal biopsy sample. Definitive diagnosis was achieved by the demonstration of Mycobacterium tuberculosis nucleic acid in kidney biopsy by polymerase chain reaction (PCR). Antituberculosis therapy was not initiated since there were no signs of active tuberculosis. The patient became clinically stable following dialysis and was discharged, however, she has been undergoing hemodialysis three times a week. The aim of this case presentation was to emphasize that renal tuberculosis should be considered in the differential diagnosis of patients with end stage renal failure, especially in countries like Turkey where tuberculosis incidence is high.

Renal Tuberculosis Following Intravesical Bacillus Calmette-Guérin (BCG) Immunotherapy for the Treatment of Bladder Cancer.

INTRODUCTION: Non-muscle-invasive bladder cancer (NMIBC) is usually effectively treated with transurethral resection (TUR), most often followed by intravesical instillation of bacillus Calmette-Guérin (BCG) or intravesical chemotherapy. Although the precise mechanism of BCG immunotherapy is still unclear, a local immune response is presumed. However, a number of severe side effects and complications are related to intravesical immunotherapy. AIM: Aim of this report is to present rare case of the renal granulomatous disease in a patient previously treated with intravesical instillation of BCG immunotherapy, following TURBT. In addition, we performed review of previously reported cases of renal granulomas following intravesical BCG immunotherapy. CASE REPORT: A 79-year-old man was presented to Urology Clinic due to clinically verified tumor of the urinary bladder. After transurethral resection of bladder tumor, histopathological analysis revealed the diagnosis of papillary urothelial high-grade pT1 carcinoma. Intravesical BCG immunotherapy was initiated, according to protocol currently used in our institution. Upon completion of therapy with BCG, we re-examined the patient and, using ultrasound, found a change in the right kidney, resembling moth bites not seen on CT scan before TURBT. Additionally, CT-guided core-needle biopsy of the affected kidney was performed, and the specimen was sent for histopathological analysis, which revealed chronic necrotizing granulomatous inflammation. Antituberculotic therapy was initiated for 6 months. Upon completion of antituberculotic therapy, control CT-scan was performed at follow-up, indicating regression of changes on the right kidney. CONCLUSION: This case report emphasizes the importance of consistent implementation of follow-up protocol and the identification of lesions during the asymptomatic period and enables the proper treatment of the disease. To reduce the incidence of adverse effects of BCG treatment for bladder tumors, an individualized approach is needed.

Renal allograft tuberculosis: report of three cases and review of literature.

Renal transplant recipients are prone to a variety of infections due a persistent immunodepleted state. Incidence of tuberculosis in this population is much higher compared with the general population. While pulmonary tuberculosis still remains the commonest form in this population, renal allograft tuberculosis is very rare. We report two cases of isolated allograft tuberculosis and one case of allograft tuberculosis with coexistent pleuro-pulmonary and bone marrow involvement. All three cases had presented with pyrexia of unknown origin, wherein despite extensive investigations the cause was not found. In two cases the diagnosis was confirmed on histology. Two cases responded to non-rifampicin-based modified antitubercular treatment and one to conventional four-drug Rifampicin-based regimen. Graft function improved in two cases while in one case the graft was lost. Tuberculosis involving the renal allograft is a potential cause for graft dysfunction/loss and requires a high index of suspicion for diagnosis. Timely detection and early institution of therapy can help save the renal allograft.

Renal tuberculosis in adult polycystic kidney disease: report of 2 cases and review of the literature.

Adult polycystic kidney disease (APKD) is a common and potentially fatal disease, leading to end-stage renal failure in 50% of cases. The disease is frequently complicated by arterial hypertension, bacterial pyelonephritis, and hematuria. The association between APKD and tuberculosis has rarely been reported and is related to a more unfavorable course since the infection becomes refractory to specific treatment. The authors report 2 cases of renal tuberculosis diagnosed in the native nephrectomy specimens of 2 patients with APKD after renal transplantation. Tuberculosis, although not common, must be recognized as a potential source of infection of native polycystic kidneys in immunocompromised transplant recipients.

Chronic kidney disease related to renal tuberculosis: a case report.

Genitourinary tuberculosis (TB) is the third most common form of extrapulmonary TB. A 34-year-old man with severe kidney function loss secondary to renal TB initially presented with urinary symptoms, including dysuria and polacyuria. The diagnosis was based on clinical history and laboratory tests; the urinalysis revealed acid-fast bacilli. The patient's condition stabilized after beginning TB-specific treatment, but the right kidney function loss persisted. Renal TB can lead to irreversible loss of renal function. As such, renal function should be considered in all patients from TB-endemic areas who present with urinary symptoms and whose urine cultures are negative for common pathogens.

The role of ultrasound and echo-color Doppler in the diagnosis and follow-up of tuberculosis of the transplanted kidney.

Tuberculosis is still a relatively frequent, serious disease developing in kidney transplant patients, having an overall incidence estimated to range between 0.35 and 15%. The disease often presents with unusual clinical manifestations, partly due to the more frequent extra-pulnipnary localizations. We describe the clinical case of a 49-year-old patient who had undergone a bilateral kidney transplant from a 70-year-old donor. About 8 months after the transplant he developed fever and raised serum creatinine values were found, together with subcutaneous abscesses in the groin, along both surgical wounds, and on the external genital area. Ultrasound and radiographic imaging demonstrated the presence of multiple intra-abdominal abscesses, localized at the level of the spleen hilus, of the left transplanted kidney and the right parietocolic retroperitoneum. Positive cultures were obtained to Mycobacterium Tuberculosis and the patient was administered anti-tubercular treatment with Etambutol, Isoniazide, and Rifabutin. The initially prescribed immune suppressive treatment (Corticosteroids, Cyclosporin and Micophenolate) was progressively reduced to only 5 mg/die of Prednisone. After 6 months from the start of the anti-tubercular treatment the patient showed an improvement of the clinical and radiological picture, as well as preservation of the renalfunction.

Senior-Loken syndrome (nephronophthisis and tapeto-retinal degeneration): a study of 8 cases from 5 families.

The association of nephronophthisis and tapeto-retional degeneration was described by both Senior and Loken in 1961, but prior to 1974 only 28 cases had been published. This report describes 8 new cases in 27 members of 5 families. The severe juvenile type produces blindness in infancy and death from renal failure before the age of ten. The adult type is characterized by later onset, slower progression of the renal disease and milder ocular manifestations. The eye disease may be congenital amaurosis of Leber type, pigmentary retinal degeneration or retinitis punctata albescens and the electroretinogram (ERG) is of value in the diagnosis of these varieties of hereditary tapeto-retinal degeneration. Renal involvement is often asymptomatic. Defective urinary concentration leading to polyuria and polydipsia is the earliest sign. Proteinuria is inconstant and urinary sediment is often normal. Two patients had aminoaciduria. The disease progresses inexorably to chronic renal failure. One patient has been successfully transplanted and two others are on chronic hemodialysis. Renal histological changes are those of nephronophthisis with tubulointerstitial lesions and multiple cysts. Senior-Loken syndrome appears to be transmitted by a single autosomal recessive pleotropic gene of variable expression. Degeneration of neuroepithelium and renal tubular epithelium, both tissues of ectodermal origin, may represent a genetically determined enzyme abnormality.

Tuberculosis in living related donor renal transplant recipients.

Ten out of 237 patients who underwent renal transplantation between 1975 and October 1986 developed tuberculosis. Most patients presented with vague symptoms, and typical symptoms commonly associated with tuberculosis were not common. Six had positive urine cultures. One patient had positive sputum and urine cultures and one had positive sputum and cerebrospinal fluid cultures for tuberculosis. In this last patient cryptococcus was also cultured from the sputum and CSF. Nine of the 10 patients responded well to antituberculosis therapy and was cured of the infection. The patient with associated cryptococcal infection died 2 months after presentation. Side effects of antituberculous therapy was minimal and easily resolved on stopping the offending drug.

On the increase of the percentage of females among patients with infectious and calculous renal diseases and on its possible causes.

The study of sex distribution revealed an increase of the percentage of females among more than 12 000 patients with pyelonephritis, renal tuberculosis and nephroureterolithiasis in the period 1959-73 from 69 to 75%, from 63 to 69% and from 54 to 64%, respectively. The tendency revealed may be explained by a decrease of the role of general causal factors, which are of the same importance for males and females, and by the relative increase of the role of local factors, which are of greater importance for females due to pregnancy, delivery, and gynecological disorders. The role of the latter factors in the pathogenesis of infectious and calculous renal diseases in women is confirmed by the study of the history and the fate of female patients and by a more frequent affection of their right kidney. Women after complicated pregnancy and delivery, gynecological diseases and genital surgery need regulat dispensary urological observation to prevent and detect early infectious and calculous renal diseases.

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.

Granulomatous interstitial nephritis in renal transplant recipient.

Tuberculosis of a transplanted kidney is a rare and serious complication. Search for renal tuberculosis as the cause of deterioration of graft function is mandatory in a renal transplant recipient with tuberculosis of other organs e.g. pulmonary tuberculosis in this patient. Renal histopathology is required for the diagnosis. Treatment with anti-tuberculosis drugs can improve renal function. Drug interactions should be considered when rifampicin is administered with cyclosporin A.

[Meningeal tuberculosis and renal lithiasis. A case report]. / Tuberculose méningée et lithiase rénale. A propos d'un cas.

Urinary tuberculosis is frequent in Algeria. The discovery of the disease become difficult when one of the three criterium of the diagnostic does not allow a diagnosis of certitude. The authors reported the case of a 44 years-old patient admitted to hospital for tuberculous meningitis recovery from left nephrectomy for urinary lithiasis. The histology does not find specific lesions. Then, no antituberculous treatment is prescribed. The patient has developed renal and meningitis tuberculosis associated with urinary lithiasis. Koch's bacillus is found in the urine. The evolution under medical treatment was excellent. The urinary lithiasis has hided tuberculosis and the discovery of the disease was late.

[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.

[Tuberculosis in patients on long-term hemodialysis]. / Gruzlica u pacjentów przewlekle dializowanych.

On the basis of an analysis of the pertinent literature and own material the problems are presented connected with the diagnosis and treatment of tuberculosis in patients with terminal renal failure treated with chronic dialysis programmes. Much place has been given to diagnostic difficulties and dosage of antituberculous drugs in this disease. The analysis of own material indicated that early started and continued consequently treatment gives a high likelihood of cure.

[Pathogenetic justification of organ-preserving operations and their role in improving the effectiveness of the comprehensive treatment of renal tuberculosis]. / Patogeneticheskoe obosnovanie organosokhraniaiushchikh operatsii i ikh rol' v povyshenii éffektivnosti kompleksnogo lechenii tuberkuleza pochek.

Some experimental data concerning the pathogenesis of tuberculous injury to the kidneys have been obtained from a complex study of the microcirculatory blood bed on a model of tuberculosis of the kidneys in 112 rabbits. Clinical investigations and clinico-experimental correlations have provided pathogenetic grounds for a surgical method of the treatment of tuberculosis of the kidneys complicated with strictures or the ureter. The pathogenetic association of the main tuberculous focus in the renal parenchyma with the tuberculous injury to the ureter and perivascular expansion of specific infection has been pointed to. The effectiveness of pathogenetically grounded surgical intervention has been proved in 52 patients followed-up from 1.5 to 7 years.

Chronic kidney disease related to renal tuberculosis: a case report

Abstract: Genitourinary tuberculosis (TB) is the third most common form of extrapulmonary TB. A 34-year-old man with severe kidney function loss secondary to renal TB initially presented with urinary symptoms, including dysuria and polacyuria. The diagnosis was based on clinical history and laboratory tests; the urinalysis revealed acid-fast bacilli. The patient's condition stabilized after beginning TB-specific treatment, but the right kidney function loss persisted. Renal TB can lead to irreversible loss of renal function. As such, renal function should be considered in all patients from TB-endemic areas who present with urinary symptoms and whose urine cultures are negative for common pathogens.