Renal tuberculosis

Renal tuberculosis is the most common extrapulmonary organ form of tuberculosis, occurring in 30-40% of cases of primary pulmonary lesions. Renal, urinary tract, and genital tuberculosis is called urogenital.

Epidemiology

The overall incidence of tuberculosis in Russia in 1990 was 34 cases per 100,000 population, by 2000 it had increased almost 3-fold to 90.7 per 100,000 population. If in the first half of the 20th century the priority among extrapulmonary forms of tuberculosis belonged to bone and joint, since the 1950-1960s it has been replaced by urogenital. The share of the latter is gradually increasing: if in 1971 among all forms of extrapulmonary tuberculosis urogenital was 29.1%, then by 1984 its frequency 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.

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Causes renal tuberculosis

The main source of infection is the patient releasing mycobacteria into the environment. The main route of penetration of the pathogen into the kidney is hematogenous. This usually occurs at the stage of formation of the pulmonary focus, when the "non-sterile" immunity to the pathogen does not function properly. However, hematogenous spread of mycobacteria in the body is possible already in the first hours after airborne or alimentary infection.

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

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Symptoms renal tuberculosis

Symptoms of kidney tuberculosis are, unfortunately, few and non-specific. In the parenchymatous stage, when foci of inflammation are present only in the organ tissue, clinical manifestations may be minimal, scanty: mild malaise, occasionally subfebrile temperature. In 30-40% of patients, clinical manifestations may be absent. As the process progresses, pain in the lumbar region, macrohematuria and dysuria may occur. With tuberculosis of the right kidney, pain in the right side may be observed.

Renal tuberculosis is a disease characterized by pain on the affected side in 7% of patients at the initial stage and in 95% with an advanced destructive process; the pain may be dull and aching against the background of progression of infiltrative inflammation and gradually developing processes that disrupt the outflow of urine from the kidney. When destruction occurs, rejection of necrotic caseous masses, especially with changes in the ureteropelvic segment and ureter, the pain may resemble renal colic with all its clinical features, accompanied by chills, fever, and signs of intoxication. However, vivid manifestations of an acute inflammatory process in the kidney may be absent.

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Treatment renal tuberculosis

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. The use of fluoroquinolones (lomefloxacin) has opened up certain prospects in recent years. Renal tuberculosis is treated with anti-tuberculosis drugs.

This treatment should be comprehensive, using the entire arsenal of means, 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.