Review of genitourinary tuberculosis with focus on end-stage renal disease

Abstract

SUMMARYTuberculosis (TB) is a current public health problem, remaining the most common worldwide cause of mortality from infectious disease. Recent studies indicate that genitourinary TB is the third most common form of extra-pulmonary disease. The diagnosis of renal TB can be hypothesized in a non-specific bacterial cystitis associated with a therapeutic failure or a urinalysis with a persistent leukocyturia in the absence of bacteriuria. We report on the case of a 33-year-old man who presented on admission end stage renal disease (ESRD) secondary to renal TB and a past history of pulmonary TB with important radiologic findings. The diagnosis was based on clinical findings despite all cultures being negative. Empiric treatment with tuberculostatic drugs was started and the patient became stable. He was discharged with no symptom, but without renal function recovery. He is on maintenance hemodialysis three times a week. TB is an important cause of kidney disease and can lead to irreversible renal function loss.

Renal Tuberculosis in the Modern Era

“…Greece has the highest incidence of TB (4.5% of new cases). We have seen a recent apparent increase in the cases admitted to the emergency department with uremia caused by renal TB, 21,23,29 and this can be attributed to an increase in the incidence of renal TB or an increase in the medical suspicion of this infection, which leads to correct diagnosis of ESRD etiology.…”

“…In patients with bilateral ureteral distortion, the disease progression leads to a significant decrease in the GFR and might evolve to ESRD. 19,29 Contrasted tomography can detect renal exclusion in the setting of TB progression to ESRD (Figures 7 and 8) and lymphadenomegaly ( Figure 9). 23,29 Patients suspected of having renal TB should also be screened for asymptomatic pulmonary lesions, such as cavitations or nodules (Figure 10).…”

“…19,29 Contrasted tomography can detect renal exclusion in the setting of TB progression to ESRD (Figures 7 and 8) and lymphadenomegaly ( Figure 9). 23,29 Patients suspected of having renal TB should also be screened for asymptomatic pulmonary lesions, such as cavitations or nodules (Figure 10). 23 Nuclear magnetic resonance can also detect pyelocaliceal system and ureter dilation (Figure 11).…”

Chronic kidney disease related to renal tuberculosis: a case report

“…Renal TB is a commonly overlooked genitourinary disease, but it must be considered in patients from TB-endemic regions who present with urinary symptoms and who do not respond to typical antibiotic treatment. Renal TB is the most likely diagnosis in patients who present with pyuria and hematuria and who have negative urine cultures (1) (3) (6) . Renal TB occurs secondary to a primary pulmonary infection after the bacilli reaches other organs, typically through hematologic dissemination, although in many cases this primary infection can be asymptomatic or may manifest as mild, unspecific symptoms (1) .…”

“…Renal scintigraphy indicated severe function loss in this kidney, and the patient experienced worsening kidney function even after TB treatment ended. There have been no previous reports of renal TB leading to end-stage kidney disease (6) , which may also lead to death (7) . Notably, this patient experienced chronic kidney disease due to severe loss of function only in the right kidney, which highlights the unilateral TB involvement in this kidney.…”