End-stage renal disease due to delayed diagnosis of renal tuberculosis: a fatal case report

Abstract

Renal TB is difficult to diagnose, because many patients present themselves with lower urinary symptoms which are typical of bacterial cystitis. We report a case of a young woman with renal TB and ESRD. She was admitted with complaints of adynamia, anorexia, fever, weight loss, dysuria and generalized edema for 10 months. At physical examination she was febrile (39ºC), and her abdomen had increased volume and was painful at palpation. Laboratorial tests showed serum urea=220mg/dL, creatinine=6.6mg/dL, hemoglobin=7.9g/dL, hematocrit=24.3%, leukocytes=33,600/mm 3 and platelets=664,000/mm 3 . Urinalysis showed an acid urine (pH=5.0), leukocyturia (2+/4+) and mild proteinuria (1+/4+). She was also oliguric (urinary volume <400mL/day). Abdominal echography showed thick and contracted bladder walls and heterogeneous liquid collection in the left pelvic region. Two laparotomies were performed, in which abscess in pelvic region was found. Anti-peritoneal tuberculosis treatment with rifampin, isoniazid and pyrazinamide was started. During the follow-up, the urine culture was found to be positive for M. tuberculosis. Six months later the patient had complaints of abdominal pain and dysuria. New laboratorial tests showed serum urea=187mg/dL, creatinine=8.0mg/dL, potassium=6.5mEq/L. Hemodialysis was then started. The CT scan showed signs of chronic nephropathy, dilated calyces and thinning of renal cortex in both kidneys and severe dilation of ureter. The patient developed neurologic symptoms, suggesting tuberculous meningoencephalitis, and died despite of support measures adopted. The patient had ESRD due to secondary uropathy to prolonged tuberculosis of urinary tract that was caused by delayed clinical and laboratorial diagnosis, and probably also due to inadequate antituberculous drugs administration.

Renal Tuberculosis in the Modern Era

“…Advanced disease may cause obstructive uropathy, bladder defects, and loss of kidney function. 21 Ultrasonography, computerized tomography, and magnetic nuclear resonance will demonstrate grossly distorted ureters, with alternating stenotic and dilated areas, reduced bladder volume, hydronephrosis, and reduced kidneys in advanced disease. 21,22 Intravenous urography may show chalice distortion or cavities suggestive of pelvic lesions of TB and loss of right kidney function.…”

“…21 Ultrasonography, computerized tomography, and magnetic nuclear resonance will demonstrate grossly distorted ureters, with alternating stenotic and dilated areas, reduced bladder volume, hydronephrosis, and reduced kidneys in advanced disease. 21,22 Intravenous urography may show chalice distortion or cavities suggestive of pelvic lesions of TB and loss of right kidney function. 21,23 CUTANEOUS AND RENAL TUBERCULOSIS There is association between renal and cutaneous TB.…”

“…21,22 Intravenous urography may show chalice distortion or cavities suggestive of pelvic lesions of TB and loss of right kidney function. 21,23 CUTANEOUS AND RENAL TUBERCULOSIS There is association between renal and cutaneous TB. We treated a 40-year-old woman ale who was given an established diagnosis of cutaneous TB (erythema induratum of Bazin).…”

Tuberculose Urinária: Graves Complicações Podem Ocorrer com um Diagnóstico Tardio

“…[1][2][3][4][5] A TBU pode afectar vários órgãos do sistema urinário, sendo o rim o mais frequentemente envolvido (60,8% -100%), seguido dos ureteres (18,6 -40,7%).…”

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

“…The occurrence of extra-pulmonary TB is not common in HIVnegative patients, and the development of end-stage kidney disease caused by TB is even less common, being rarely reported in medical literature 5,7,17 . Following the patient's consent, we report on the case of a young man with a past history of pulmonary TB treated for six months with rifampicin, isoniazid and pyrazinamide (RIP), who presented on admission ESRD secondary to renal TB.…”