Kidney Tuberculosis - Treatment

Treatment of renal tuberculosis should be individual and include the use of specific anti-tuberculosis drugs. They are divided into primary (first-line) and reserve. The first-line drugs include isonicotinic acid hydrazides (isoniazid, etc.), rifampicin, ethambutol and streptomycin, and the second-line reserve drugs include ethionamide, prothionamide, cycloserine, aminosalicylic acid, kanamycin, etc. Certain prospects have been opened up in recent years by the use of fluoroquinolones (lomefloxacin). Treatment of renal tuberculosis with anti-tuberculosis drugs should be comprehensive, using the entire arsenal of drugs, with individual dosage taking into account the nature and stage of the process, the general condition of the patient, the severity of tuberculosis intoxication, the state of other organs and systems. It should be taken into account that many anti-tuberculosis drugs can impair liver and kidney function, cause severe dysbacteriosis, allergic and other undesirable side effects. Conservative drug treatment of renal tuberculosis should be combined with angioprotectors and non-specific NSAIDs that prevent the proliferation of coarse connective tissue. If there are signs of impaired urine outflow from the affected kidney, it should be restored by installing a catheter-stent or using nephrostomy. Conservative treatment carried out at the first stages should be long-term (6-9 months, sometimes up to a year). Only after assessing the results of conservative therapy in cases of destructive renal tuberculosis is the issue of surgical treatment decided.

In tuberculous pyonephrosis, long-term treatment with tuberculostatics is futile. A preoperative therapy course of 2-3 weeks with subsequent nephrectomy and continuation of specific treatment to prevent an outbreak of the tuberculous process in the only remaining kidney is sufficient. If the destructive process is local in nature with damage to one of the kidney segments, specific therapy should be further combined with removal (nephrectomy, cavernotomy) or sanitation (cavernotomy) of the altered areas. If the angioarchitecture of the affected kidney allows (according to complex angiography data), preference should be given to resection of the kidney with subsequent specific drug treatment of renal tuberculosis among organ-preserving operations. Bilateral tuberculosis or tuberculosis of the only kidney lead to the development of progressive chronic renal failure. In this case, appropriate treatment by a nephrologist using extracorporeal detoxification methods (hemodialysis) is necessary.

The prognosis for the course of renal tuberculosis can be assessed as favorable only if early diagnosis and successful conservative treatment of renal tuberculosis are made.

Medical examination for tuberculosis of the kidneys

Every clinician: urologist, nephrologist, internist, phthisiologist, - working in an outpatient clinic and in a hospital, must remember that kidney tuberculosis is a real problem. If kidney and urinary tract tuberculosis is suspected, the patient must be referred to a specialized anti-tuberculosis institution.

All patients who have had pulmonary tuberculosis, despite clinical recovery, should be registered with a dispensary and undergo periodic examination, since they may develop renal tuberculosis. Systematic (at least 2 times a year) urine tests, annual ultrasound examination of the kidneys can greatly help in the early detection of renal tuberculosis and will improve the results of renal tuberculosis treatment.

[ 1 ], [ 2 ], [ 3 ], [ 4 ]