Tuberculosis of the kidneys

Tuberculosis of the kidneys. Mycobacterium tuberculosis enters the kidney by hematogenesis. Sometimes kidney tuberculosis can be a manifestation of disseminated tuberculosis.

Pathogenesis. For the occurrence of the tuberculosis process in the kidney, in addition to the penetration of mycobacteria, favorable conditions are necessary for them, a special immunopathological state of the body and kidney tissue. The spread of the pathological process to the urinary tract occurs through the lymphatic ways. The pathological anatomy is characterized by diversity: from specific exudation and proliferation, from the appearance of specific tubercles to the formation of cavities and ulceration of the papillae of the kidney and urinary tract. A specific inflammation of the interstitial tissue develops around the focus of tuberculous lesions.

Symptoms, course. At the onset of the disease, there are no characteristic features. Complaints of weakness, fatigue, low-grade fever, combined with blunt and undefined pain in the lumbar region, forcefully examine urine. Chronic pyuria is the most common manifestation of kidney tuberculosis, but microhematuria can also be an early symptom of the disease. Urine is almost always an acid reaction, it contains a lot of leukocytes, and proteinuria is poorly expressed. When urine is sown to ordinary media, it remains sterile, as mycobacteria displace another flora, and they do not grow on ordinary media. Piuria rarely forces a patient to see a doctor, most often he is disturbed by an admixture of blood in his urine or an attack of renal colic. The spread of the pathological process to the urinary tract is accompanied by increased pain in the lumbar region and painful dysuria. Sometimes, with late diagnosis of the disease, urethra, prostate and testicles with appendages are involved in the process.

The diagnosis of kidney tuberculosis is based on the data of a urological examination, but early recognition is possible if one remembers that under the mask of chronic pyelonephritis, kidney tuberculosis often occurs, that aseptic pyuria can be present in the presence of mycobacterium tuberculosis in the urine, which is one of the causes of chronic cystitis is tuberculosis. Not only pyuria, but also microhematuria, if their cause is not accurately established, serve as a reason for repeated urine testing for mycobacterium tuberculosis (seeding on special media, contamination of guinea pig). Detection of mycobacterium tuberculosis in urine confirms the diagnosis. A reliable sign of tuberculosis of the urinary system is also the detection of tuberculous tubercles on the mucous membrane of the bladder and signs of caverns on the pyelogram. If a kidney tuberculosis is suspected, the patient is shown a urological examination.

Treatment. Conservative treatment requires the use of specific anti-tuberculosis drugs (isoniazid 300 mg once a day or rifamycin 300 mg twice a day in combination with ethambutol 400 mg 3 times a day) and activities that increase the body's resistance. Treatment is usually carried out in an anti-TB dispensary or in special hospitals and sanatoria (especially in the autumn and spring periods). Polycavernous process requires surgical treatment.

The prognosis for early diagnosis and timely treatment is favorable.