Chronic kidney disease with genitourinary tuberculosis: old disease but ongoing complication

Abstract

BackgroundGenitourinary tuberculosis (GUTB) is a type of extrapulmonary TB that exerts a deleterious effect on renal function by promoting renal calcification and ureteric stricture. Therefore, we investigated the risk factors for chronic kidney disease (CKD) in GUTB patients after the end of treatment.MethodsThis retrospective study was conducted at a tertiary hospital in South Korea. Data from patients (>18 years of age) with GUTB were collected from January 2005 to July 2016. CKD was defined as a glomerular filtration rate <60 mL/min/1.73m2 after the end of treatment.ResultsIn total, 56 patients with GUTB (46.4% males; mean age 52.8 ± 16.6 years) were enrolled in the study. CKD developed in 11 (19.6%) patients and end-stage renal disease in 4 (7.1%). In a univariate analysis, older age (p = 0.029), microscopic haematuria (p = 0.019), proteinuria (p = 0.029), acute renal failure (ARF) (p < 0.001) and a positive polymerase chain reaction-based test result for TB in the urine (p = 0.030) were significantly associated with decreased renal function. In a multivariate analysis, ARF (odds ratio [OR], 54.31; 95% confidence interval [CI], 1.52–1944.00; p = 0.032) and old age (OR, 54.26; 95% CI, 1.52–1932.94; p = 0.028) were independent risk factors for CKD in GUTB patients.ConclusionsARF and old age were independent risk factors for CKD in GUTB patients. Therefore, in elderly GUTB patients with ARF at the time of diagnosis, regular follow-up of renal function should be performed even after the end of treatment.

Presentación de reporte de caso: estallido renal espontáneo por tuberculosis

“…(1) En casos más complejos, se presentan pacientes con complicaciones asociadas como insuficiencia o enfermedad renal crónica. (2,8,9) El estándar de oro es el aislamiento y cultivo del bacilo de Mycobacterium tuberculosis en muestras de orina, debido a que la baciluria es esporádica y leve, se requiere el análisis de tres a nueve muestras seriadas. El cultivo del bacilo presenta una sensibilidad variable (10.7% al 90%) con una desventaja en su análisis por el tiempo de obtención de los resultados (días hasta semanas) de acuerdo al centro de referencia.…”

Update on urogenital tuberculosis in Southern Tunisia: a review of a 26-year period

“…4 The kidneys, the most commonly involved site in UGTB, were affected in 80% of the cases, while the epididymis was the most commonly affected genital organ in about 22-55% of the cases. 4,6 In the 2019 Global TB report, TB incidence in Tunisia was 35 cases / 100 000 population, 7 and EPTB cases noted an increase through the few last years, reaching 20 to 40% of all TB cases. 8 The late onset of symptoms of UGTB, its myriad presentations and the insidious evolution explained the diagnosis and treatment delay.…”

Recent Trends in Diagnosis of Urogenital Tuberculosis

“…However, concomitant UGTB and pulmonary TB (PTB) are found in 2-10 and 15-20% of patients in developed and developing nations, respectively [2]. In fact, UGTB occurs after a prolonged period of latent infection followed by hematogenous spread to the kidneys, fallopian tubes and epididymis [3]. The clinical manifestations of female UGTB include primary or secondary infertility, menstrual dysfunction and pelvic inflammatory disease [4].…”

“…Similarly, the most frequent sites for male UGTB are the epididymis and prostate followed by seminal vesicles and testicles originating from renal foci, which also lead to infertility [6]. Owing to asymptomatic nature and varied clinical presentations (ranging from vague urinary symptoms to chronic kidney disease) that mimic several urologic and genital diseases, diagnosis of UGTB is a daunting challenge [3].Smear/culture, histopathology, interferon-γ release assays (IGRAs), intravenous pyelography, laparoscopy and nucleic acid amplification tests (NAATs) are the main modalities employed in the diagnosis of UGTB [6][7][8], which have certain limitations. Smear microscopy and culture for Mycobacterium tuberculosis identification (on Lowenstein-Jensen medium or BACTEC-460/MGIT-960) are commonly used methods but they lead to poor sensitivities due to paucibacillary nature of specimens [7].…”

“…Similarly, the most frequent sites for male UGTB are the epididymis and prostate followed by seminal vesicles and testicles originating from renal foci, which also lead to infertility [6]. Owing to asymptomatic nature and varied clinical presentations (ranging from vague urinary symptoms to chronic kidney disease) that mimic several urologic and genital diseases, diagnosis of UGTB is a daunting challenge [3].…”