Kidney Tuberculosis - Treatment

Treatment of kidney tuberculosis should be individual and include the use of specific anti-tuberculosis 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). Treatment of tuberculosis of the kidneys with anti-TB drugs should be comprehensive using the whole 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 condition 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. Conservative drug treatment of kidney tuberculosis should be combined with the use of angioprotectors and nonspecific NSAIDs that prevent the proliferation of coarcted connective tissue. With signs of a violation of urinary outflow from the affected kidney, it must be restored by establishing a stent catheter or using nephrostomy. Conservative treatment, conducted in the first stages, should be long (6-9 months, sometimes up to a year). Only after evaluating the results of conservative therapy in cases of destructive tuberculosis of the kidney is the question of surgical treatment addressed.

With tuberculosis pionefroze, long-term treatment with tuberculostatics is futile. There is enough course of preoperative therapy for 2-3 weeks with subsequent nephrectomy and continuation of specific treatment to prevent the outbreak of tuberculosis in the only remaining kidney. If the destructive process is local in nature with the defeat of one of the segments of the kidney, specific therapy should be combined with removal (resection of the kidney, cavernectomy) or sanation (cavernotomy) of the altered areas. If the angioarchitectonics of the affected kidney allows (according to the data of complex angiography), among the organ-preserving operations, preference should be given to the resection of the kidney followed by specific medication for kidney tuberculosis. Bilateral lesion with tuberculosis or tuberculosis of a single kidney leads to the development of progressive chronic renal failure. In this case, appropriate treatment is needed in the nephrologist with the use of extracorporeal detoxification (hemodialysis) methods.

The prognosis of kidney tuberculosis can be assessed as favorable only on condition of early diagnosis and successful conservative treatment of kidney tuberculosis.

Clinical examination for tuberculosis of the kidneys

Each clinician: urologist, nephrologist, internist, phthisiatrist, - working in an outpatient clinic and a hospital, should remember that kidney tuberculosis is a real problem. If there is a suspicion of tuberculosis of the kidney and urinary tract, the patient should be referred to a specialized anti-tuberculosis institution.

All patients who have undergone pulmonary tuberculosis, despite the clinical cure that has come, should be on dispensary records and be periodically examined, as they may have kidney tuberculosis. Systematic (at least 2 times a year) urinalysis, an annual ultrasound of the kidneys can greatly help early detection of kidney tuberculosis and will improve the results of treatment of kidney tuberculosis.

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