Tuberculosis of the kidney: causes, symptoms, diagnosis, treatment, predictions

Renal tuberculosis is a secondary infectious disease, most often affecting those who have already had tuberculosis in the pulmonary form. With timely intervention, the ailment is curable. Tuberculosis is an infectious disease that affects both humans and animals. The most common is pulmonary tuberculosis. However, even in the old days, a similar kidney disease was considered as a separate ailment and was called "tubercle".The same source causes the disease, Koch's wand.

Tuberculosis of the kidneys - what is it?

This disease is 30-40% of the non-pulmonary form of tuberculosis and ranks first. As a rule, nephrotuberculosis is found in patients who have undergone a pulmonary form: according to statistics, 30-40% of people who have treated pulmonary form also have a similar disease of the kidneys and the genitourinary system.

Women get sick less often: only about 5-10% of patients with pulmonary tuberculosis. In men, the disease in 50% of cases passes to the prostate and testicles and is difficul

t.

The disease develops 2-3 years, may not manifest itself to 15 years. Many researchers believe that infection of the kidney occurs at the same time as the lungs, but as the disease develops more slowly, it is found much later. The clinical picture is blurred, which greatly complicates the diagnosis. As a result, in most cases, the last stages of the disease are fixed.

Koch's wand with arterial blood enters the kidney. Unfortunately, the structure of the kidney is such that it contributes to the development of the disease. There are many small arteries here that provide wide access, in the renal glomeruli the blood flow is slowed down, that is, the sticks are not discharged by the stream - all this contributes to the formation of multiple primary foci.

On photo kidney with tuberculosis

Causes, pathogenesis and clinical picture of kidney tuberculosis

Causes of

The source is mycobacterium tuberculosis of human or very rarely bovine type. In the kidney, the bacterium enters the hematogenous way, that is, through the blood, however, the infection itself can occur in different ways. External factors - a stick of Koch can get into the body from the carrier. This does not mean the 100th infection. The point is the presence or absence of specific immunity. In the first case, the mycobacterium will most likely remain inactive. In the second case, the probability of infection increases dramatically. The greatest risk is to people who already have some form of inflammation of the urinary tract. Often the factor for infection is the use of an immunosuppressant, a drug that suppresses the immune system. This is the reason for the increased incidence of disease in developed countries.

  • Internal factors - much more often nephrotuberculosis develops in people who have had the disease in a pulmonary or some other form. When a disease occurs, the Koch's rod must fall into the kidney. But if the immune system is strong enough, the infection in this area will be suppressed. Otherwise, kidney tuberculosis develops.
  • In 50% of cases in men, tuberculosis affects the testicles and prostate. In women, the sexual organs are affected only in 5-10%.

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    In children, if the infection has occurred, the course of the disease does not differ from the course of the disease in adults.

    Pathogenesis of

    Pathogenesis of kidney tuberculosis Tuberculosis begins with the entry of mycobacterium into the renal parenchyma with blood flow. As a rule, the disease begins with a two-sided granuloma formation. But over time, symmetry disappears: in one of the kidneys, fear develops until caverns and dehumidification appear, while in the other, it virtually subsides. No factor determining the pattern of lesion of the right or left kidney has been identified.

    The condition of the kidney is very important at the time of infection. Favorable for Koch's wand are infection of the urinary system, chronic kidney diseases and ailments leading to delayed blood flow - diabetes mellitus, for example.

    • At the initial stage, a specific granulomatous inflammation begins in the cortical layer, with the tubercles forming immediately in the set. This is explained by the structure of the kidney: all incoming blood passes through the glomeruli and mycobacteria immediately enter them.

    The level of damage is determined by the number of mycobacteria. However, regardless of the degree of symptoms at this stage is very lubricated: there may be general malaise, sometimes a fever. Back pain is either very weak or absent completely. The first stage can last for years, turning into chronic tuberculosis. Small foci quite often completely heal and cicatrize independently, but the dead Mycobacteria can be in the kidney in a passive state for a very long time.

    • In the second stage, tuberculosis of the renal parenchyma is transformed into tuberculous papillitis. The tubercles form in the brain substance and damage the papillary formations: tubules are opened on their apices, which extract urine into the kidney cups. Because of edema of the papillae, urine outflow can be disturbed, but at this stage the symptoms remain undefined.

    Most often, the reason for going to the doctor is the appearance of blood in the urine, and not accompanied by painful sensations. However, this occurs only in 1 out of 6 patients. However, in the urine, Koch's stick gets in a huge amount, which leads to damage to the walls of the bladder and ureters.

    • In the next stage, foci of inflammation can merge, and necrotic masses - go out into the lumen of calyxes and pelvis. Kidney cavities are formed in the kidney tissue. This is a sign of the development of cavernous tuberculosis. Necrotic masses can periodically block the lumen of the ureter, which leads to the appearance of severe pain by the type of renal colic. Characterized by constant aching pain in the lower back.

    Cavernous tuberculosis is accompanied by toxic nephritis and perifocal inflammation, which significantly affects the urinary function of the kidney and leads to kidney failure.

    Because the fibrous formations from the pelvis are much denser, the contents of such a cavity can break through the kidney bark. Purulent masses in this case turn out to be in the perineal cellulose tissue. It is possible to open a fistulous motion on the skin of the waist.

    • The fifth stage - the mistletoe, is characterized by the filling of the affected area with fibrous and atrophic formations. This can lead to a complete organ failure.

    Is tuberculosis of the kidney contagious? No, it is an infectious disease, but because it is secondary to tuberculosis of the lungs or other forms, and therefore it is difficult to get infected. As a rule, Koch's wand is transmitted by airborne or air-dust and is dangerous precisely because it can persist for a long time in dust and mold. However, mycobacterium can leave the kidneys only with blood or urine and these are the fluids, and are the source of infection.

    Knowing how renal tuberculosis is transmitted, the patient surrounding the nephrotuberculosis should avoid direct contact with his blood and urine, and if one person uses a toilet, you should carefully wash your hands after visiting him. The room itself once a week in a mask and gloves must be cleaned with disinfectants. To prevent infection, these measures are sufficient.

    Clinical picture of kidney tuberculosis

    Clinical picture, symptoms and diagnosis of kidney tuberculosis

    Classification of

    Classify tuberculosis of the kidney based on the severity and speed of the disease:

    • The miliary or acute form develops when a large number of pathogens enter the kidney. In this case, bilateral lesions are observed, the tubercles are formed in the cortical zone. Quite often, the miliary form passes independently, leaving behind scars on the kidney tissue.
    • Caseous - or chronic. When a small number of pathogens enter the kidneys, the inflammation develops much longer and quickly focuses in one of the kidneys. In this case, mycobacteria gradually affect an increasing amount of tissue, which leads to the formation of ulcers and the accumulation of necrotic masses. The caseous form leads to renal failure, and in the absence of treatment, to kidney failure.

    Symptoms and signs

    The initial stages of the disease can be completely asymptomatic, and dangerous. The same that appear in the early stages are so common that the suspicion of the doctor can only cause the presence in the patient's anamnesis of the transmitted pulmonary tuberculosis.

    These attributes include:

    • general malaise, lethargy;
    • elevated body temperature - up to 37.6 C;
    • rapid fatigue;
    • in some cases there is a decrease in blood pressure - at the initial stage no more than 1% of patients;
    • possible constipation, vomiting, diarrhea.

    Pain in the lumbar region appears in only 7% of patients and is not expressed.

    In the chronic course of the disease, depending on the stage in adults and children, the symptoms become more pronounced and specific:

    • dysuria - usually night, that is, frequent urination.
    • macrogematuria - the appearance of blood in the urine in 17% of patients;
    • lowering blood pressure in advanced stages occurs in 20% of patients;
    • violation of carbohydrate metabolism - kidney dysfunction leads to disruption in the processing and synthesis of proteins, which causes glucose to become the only source of energy in the body. The washing out of glucose and the breakdown of proteins leads to a strong weight loss;
    • back pain - are permanent. In the late stages are observed in 95% of patients. Attacks are possible;
    • skin pigmentation - in the late stages, when kidney failure develops.

    In children, nerfotuberculosis is extremely rare. Characteristically, there are symptoms - both initial and late, are completely identical to those described. As a rule, urine turbidity and incontinence becomes an opportunity to consult a doctor, which allows to stop the ailment at relatively early stages.
    On the video about kidney tuberculosis in children:

    Diagnosis

    Diagnosis of the disease is difficult due to nonspecific symptoms. And it concerns not only the patient's well-being, but also laboratory research. In the early stages in urine, you can identify a number of proteins and erythrocytes. LHC does not reveal pathogenic flora. More in-depth studies are needed to establish a diagnosis.

    The reason for clarifying the diagnosis in the vast majority of cases is information about the transferred disease or about direct contact with people who are sick with some form of tuberculosis, most often pulmonary, because it is the most contagious.

    • Laboratory tests can demonstrate only indirect symptoms, especially in the early stages, when the Koch sticks are still far from reaching the urine. Urinalysis shows a persistent acid reaction and the presence of protein, but there is no microflora that is common in the inflammatory process. This combination is typical for 50% of patients.
    • An increase in the number of erythrocytes in urine on the same background is also an occasion to suspect tuberculosis of the kidney.
    • More accurate information is provided bacteriological culture on mycobacteria.
    • PCR diagnostics is a test for a specific pathogen. The sensitivity of the analysis is 94%.
    • ELISA - this method allows you to determine whether there are antibodies to the pathogen in the body.
    • Tuberculosis diagnosis is a provocative test. Under the skin, inject tuberculin, and then examine the urine: with a positive response, the number of shaped elements in the urine increases.

    Instrumental studies, unfortunately, also do not give a complete picture:

    • Ultrasound - at the stages of cavity formation, it allows to assess the extent of the lesion, however at the initial stages it is ineffective.
    • The same is true for radiation diagnosis: at stages 1-2, the lesions are too small. In order to be able to detect them, at later stages, X-ray studies can detect de-infection, parenchyma condensations. This method is more informative when it comes to the urinary system.
    • Computer and magnetic resonance imaging provides data on the location of the cavity shape, their connection with calyx and pelvis, and also determine the condition of the pericardial lymph nodes. As a rule, this method of research is prescribed when they decide the question of surgical intervention.
    • Dynamic nephroscintigraphy is based on different rates of uptake and removal of radionuclide labeled by the renal parenchyma. Thus, it is easy to assess the decrease in the functionality of the organ.
    • The use of biopsy in nephrotuberculosis is ineffective. However, it is possible to study the bladder mucosa. With tuberculosis, the analysis reveals the giant cells of Pirogov-Laggans.

    It is often possible to identify tuberculosis only through differential diagnosis. It is necessary to separate this disease from medullary necrosis, for example, calyx diverticula and so on.

    Tuberculosis of the kidneys on the pyelogram

    Diagnosis and treatment of kidney tuberculosis

    Treatment of

    Treatment of the disease is entirely determined by the stage of the disease and the symptoms that are present. The methods used are conservative and operational. Treatment is carried out in specialized dispensaries and lasts at least 12 months. The apparent "popularity" of the operative intervention is due to late diagnosis: the lack of clarity of symptoms in 60% of cases causes treatment at the latest stages.

    The choice of therapy and the stage of the disease are related in this way:

    • tuberculosis of the parenchyma or renal papilla - conservative treatment;
    • cavernous tuberculosis - in 3 stages it is treated with a conservative method. Possible surgical intervention in a certain area to preserve the organ;
    • polycavernous tuberculosis or pionephrosis requires surgical intervention.

    Nephrotuberculosis presupposes an individual approach to the choice of therapy. Treatment largely depends on the stage of the disease, additional complications, liver conditions and so on. And the first stage in any case is the suppression of pathogenic microflora, which requires shock doses of antibiotics.

    • For treatment, antibiotics of the 1st line are prescribed: Ethambutol, Streptomycin, Rifampicin. If any of them causes an allergic reaction, the drug is replaced with an auxiliary: Ethionamide, Kanamycin, Cycloserin, Prothionamidine and so on.
    • The effect of drugs is reduced to the destruction of mycobacteria. At the same time infectious foci are gradually replaced by scar tissue. To reduce the number of scars in the kidney tissue, therapy is supplemented with angioprotectors and non-steroidal anti-inflammatory drugs.

    The treatment requires constant monitoring of the kidneys. Perhaps a decrease in the volume of urine, which will require the installation of a stent or urethral catheter.

    • Late stages require surgical intervention. With focal lesion, part of the kidney is removed - cavernectomy, with total damage - complete removal, nephrectomy. The operation requires preparation: before it, intensive anti-tuberculosis therapy is performed for 2-4 weeks, and after the operation - a full course of treatment in order to prevent the appearance and development of the disease in the remaining kidney.

    Moreover, it was not even known that he was contagious. Treatment with propolis with oil, meoma, birch juice and so on will not hurt, if there are no restrictions - diabetes, for example, however, they have no effect on the disease. The impact of such drugs is based on the support of immunity, and this makes sense only after the destruction of the focus of the disease.

    Forecasts

    When referring to stage 1-2 of the disease - tuberculosis of the renal parenchyma, a complete cure is possible. However, the course of treatment can last longer. It is believed that only after 2-3 years of treatment and follow-up, one can guarantee complete recovery. The control test here is the absence of changes in the analysis of urine for 3 years.

    At the same time, the forecast is affected not only by compliance with the prescriptions of the doctor, but also diet, and the regime of life. It is necessary to comply with dietary table number 11, but with a restriction on the number of soups and gravies.

    The prognosis after surgery depends largely on the severity of the lesions and the general condition of the patient. However, in this case it is generally favorable.

    Renal nephrotuberculosis is a slowly developing infectious disease that is transmitted through the blood and urine of the patient. With a timely and even late referral to the doctor, the chances of a complete cure are very high.

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