Kidney tuberculosis

Tuberculosis of the kidney is the 1 st place among extrapulmonary organ forms of tuberculosis, observed in 30-40% of cases of primary pulmonary lesions. Tuberculosis of the kidneys, urinary tract and genitals is called urogenital.

Epidemiology

The total incidence of tuberculosis in Russia in 1990 was 34 cases per 100 thousand of the population, by 2000 it had increased almost 3 times to 90.7 per 100 thousand of the population. If in the first half of the XX century. Priority among extrapulmonary forms of tuberculosis belonged to the osteoarticular, from 1950-1960-ies it was replaced by urogenital. The share of the latter is gradually increasing: in 1971, among all forms of extrapulmonary tuberculosis, the urogenital tuberculosis was 29.1%, by 1984, its incidence had increased to 42.6%, and in 2000 it was 44.8%. Tuberculosis of the kidneys occurs equally often in men and women and, as a rule, occurs at the age of 30-50 years.

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

Causes of the kidney tuberculosis

The main source of infection is a patient that secretes mycobacteria into the environment. The main path of penetration of the pathogen into the kidney is hematogenous. This happens, as a rule, at the stage of formation of the pulmonary focus, when the "non-sterile" immunity to the causative agent does not function properly. However, the hematogenous distribution of mycobacterium in the body is possible already in the first hours after aerogenic or alimentary infection.

The method of invasion (penetration of the pathogen into tissues) is closely related to the peculiarities of microcirculation in the kidneys: with the vastness of the microcirculatory bed, slowed blood flow in the capillaries of the glomeruli, close contact of the vessels with the interstitial tissue. These features contribute to the formation of multiple primary foci, primarily in the cortical layer of the kidneys. Their further development can follow the path of complete reverse development with pronounced general and local resistance to tuberculosis infection, small foci size, predominantly granulomatous (without caseous necrosis), the nature of pathomorphological changes.

[5], [6], [7], [8], [9], [10], [11]

Symptoms of the kidney tuberculosis

Symptoms of kidney tuberculosis, unfortunately, are few and not very specific. In the parenchymal stage, when inflammatory foci are only present in the tissue of the organ, clinical manifestations can be minimal, meager: mild malaise, rarely subfebrile temperature. In 30-40% of patients, clinical manifestations may be absent. As the process progresses, pain in the lumbar region, macrogematuria, and dysuria may occur. With tuberculosis of the right kidney, pain in the right side can be observed  .

Renal tuberculosis is a disease characterized by pain on the affected side in 7% of patients in the initial stage and 95% in the case of a neglected process; pain can be a dull ache on the background of the progression of infiltrative inflammation and gradually developing processes that disrupt the outflow of urine from the kidney. In the event of destruction, rejection of necrotic caseous masses, especially with changes in the ureteropelvic and ureteral segments, the pain may resemble renal colic with all its clinical features, accompanied by chills, fever, signs of intoxication. However, bright manifestations of acute inflammatory process in the kidney may be absent.

[12], [13], [14], [15]

Treatment of the kidney tuberculosis

Treatment of kidney tuberculosis should be individual and include the use of specific  anti-TB drugs. They are divided into main (first row) and reserve. To the first row, it is customary to refer the preparations of isonicotinic acid hydrazides (isoniazid, etc.), rifampicin, ethambutol and streptomycin, to second-line reserve preparations - ethionamide, prothionamide, cycloserine, aminosalicylic acid, kanamycin, etc. Certain prospects in recent years have opened up the use of fluoroquinolones Lomefloxacin). Tuberculosis of the kidney is treated with anti-tuberculosis drugs. 

This treatment should be comprehensive with the use of the entire arsenal of funds, individual dosage taking into account the nature and stage of the process, the general condition of the patient, the severity of tuberculosis intoxication, and the state of other organs and systems. It should be borne in mind that many anti-tuberculosis drugs can disrupt liver and kidney function, cause severe dysbacteriosis, allergic and other undesirable side effects.