Tuberculosis of the kidney - Causes, Symptoms, Diagnosis and Treatment

Among extrapulmonary organ lesions kidney tuberculosis is the most common form of the disease and occurs in urology in 30-40% of cases. Initially, renal tuberculosis occurs when the defeat of the cortical layer of the body. Further progression of the infection is accompanied by the disintegration of tissue, formation of cavities and caverns in the renal parenchyma, renal function. In severe cases, there is the development of tuberculosis pyonephrosis (purulent fusion of kidney tissue), involvement in the infectious process pelvis, ureter, bladder, reproductive organs.

In tuberculosis of the kidneys frequently develop genital tuberculosis which affects men the prostate, testicles, epididymis (tuberculous prostatitis, orchitis, epididymitis); women - appendages, the fallopian tubes, uterus (tuberculous oophoritis, salpingitis, endometritis).

tuberculosis after 3-10 years the flow of primary tuberculosis.

Penetration of infection in the kidney occurs mainly hematogenous route. Getting through the bloodstream to the kidneys glomerular apparatus mycobacteria form multiple tiny TB lesions. With good local and general resistance to infection and the small size of the primary foci, the latter can be subjected to a complete regression. In disorders of urodynamics and hemodynamics, as well as the decrease in protective forces of the cortical layer of the infection spreads to the brain substance, causing inflammation of the renal papillae specific - tuberculous papillitis.

With further development of renal tuberculosis in the process involves the entire thickness of the renal pyramids, there is cheesy disintegration of the latter, which is accompanied by the formation of isolated or communicating with pyelocaliceal complexes cavities. Progression of renal tuberculosis can lead to the formation of renal parenchyma multiple cavities (polikavernoznaya form) and the development of pyonephrosis. Subsequent healing of cavities flowing with cheesy foci of calcification, in which, however, can be kept viable Mycobacterium tuberculosis.

Secondary involvement of the bladder, ureter and renal pelvis complexes associated with lifogennym urinogennym mechanism or spread of tuberculosis infection.

The development of renal tuberculosis, as a rule, takes place against the background of existing local infectious processes or urodynamic - chronic pyelonephritis, kidney stones and other
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Renal colic. Bilateral violation of urodynamics is accompanied by signs of chronic renal failure.

In tuberculous lesions of the bladder (cystitis TB) joins dysuria - urinary urgency to urinate, pollakiuria, strangury, constant pain above the vagina, recurrent gross hematuria. In advanced stages of renal tuberculosis often develops hypertension.

carrying out the tuberculin test and consultation phthisiatrician. When collecting history ascertain existence of pulmonary tuberculosis in the patient and his relatives, contact with TB patients. In lean patients in a number of cases it is possible to palpate a dense, lumpy kidney. Determined Pasternatskogo pronounced symptom.

Characteristic changes in the general analysis of urine when the kidneys are resistant tuberculosis sharply sour reaction leucocyturia, proteinuria, red blood cell, Piura. Authentically to judge the presence of renal tuberculosis allows the identification mikobakteriurii, which is found using bacteriological urine culture or PCR analysis. IFA Conduct can detect antibodies to tuberculosis.

In certain cases, required to perform provocative tests with tuberculin. After subcutaneous administration of tuberculosis antigen occurs exacerbation of renal tuberculosis, which is accompanied by severe proteinuria, pyuria and mikobakteriuriey.

Ultrasound of the kidneys when they are tuberculous lesions can detect cavities, calcified lesions, assess the degree of involvement of the renal parenchyma and renal tuberculosis dynamics of recourse under the influence of the therapy.

X-ray examination of the kidneys (Review urography, excretory urography, retrograde and antegrade pyelography ureteropyelography) help to comprehensively assess the condition of the parenchyma and renal pelvis renal system, ureters, urinary bladder. Perform renal angiography to determine intraorganic angioarchitectonics if necessary partial nephrectomy.

Extensive diagnostic capabilities related to the identification of renal tuberculosis have kidney CT and MRI. Data on renal function in tuberculosis obtained by radioisotope nefrostsintigrafii.

A kidney biopsy for tuberculosis dissimination dangerous infection, but cystoscopy with biopsy of the bladder mucosa may be performed if indicated. Morphological examination biopatata bladder in some cases allows you to discover giant cells Pirogov-Langhans even in the absence of visual changes in the mucous.

Differential diagnosis of tuberculosis of the kidneys with hydronephrosis necessary, nonspecific pyelonephritis, spongy kidney megakalikozom, polycystic kidneys.

bowel dysbacteriosis, allergic reactions.

In violation of the outflow of urine from the kidney require the installation of ureteral stent or nephrostomy conduct. In the case of a local destructive process in the kidney conservative therapy complement the readjustment of the affected segment (kavernotomiey) or partial resection of the kidney (kavernektomiey). When total destruction of the body is a nephrectomy.

nephrologist with periodic inspection. The criteria for cure of renal tuberculosis is the normalization of urine, lack nephrotuberculosis recurrence by X-ray data for 3 years.

Prevention of renal tuberculosis is in compliance with specific measures (vaccination against tuberculosis) and non-specific prevention of pulmonary tuberculosis.