Tuberculosis of the genitourinary system-Urinary tract tuberculosis: Renal tuberculosis-Part I

Abstract

Tuberculosis (TB) remains a worldwide scourge and its incidence appears to be increasing due to various factors, such as the spread of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). The insidious onset and non-specific constitutional symptoms of genitourinary tuberculosis (GUTB) often lead to delayed diagnosis and rapid progression to a non-functioning kidney. Due to hematogenous dissemination of TB, there is a potential risk of involvement of the contralateral kidney too. Imaging plays an important role in the making of a timely diagnosis and in the planning of treatment, and thus helps to avoid complications such as renal failure. Imaging of GUTB still remains a challenge, mainly on account of the dearth of literature, especially related to the use of the newer modalities such as magnetic resonance imaging (MRI). This two-part article is a comprehensive review of the epidemiology, pathophysiology, and imaging findings in renal TB. Various imaging features of GUTB are outlined, from the pathognomonic lobar calcification on plain film, to finer early changes such as loss of calyceal sharpness and papillary necrosis on intravenous urography (IVU); to uneven caliectasis and urothelial thickening, in the absence of renal pelvic dilatation, as well as the hitherto unreported ‘lobar caseation’ on ultrasonography (USG). Well-known complications of GUTB such as sinus tracts, fistulae and amyloidosis are described, along with the relatively less well-known complications such as tuberculous interstitial nephritis (TIN), which may remain hidden because of its ‘culture negative’ nature and thus lead to renal failure. The second part of the article reviews the computed tomography (CT) and MRI features of GUTB and touches upon future imaging techniques along with imaging of TB in transplant recipients and in immunocompromised patients.

Genitourinary tuberculosis in North America: A rare clinical entity

“…With immune suppression, mycobacteria are reactivated and are spilled into the nephron and get trapped within the narrow loop of Henle in the papilla causing caseating papillary lesions. 4 This is when bacilli are shed into the urine spreading TB antegradely to the urothelium of the renal pelvis, ureter, bladder and adjacent genital organs. 4 Often, the involved organs may be irreversibly damaged at the time of presentation as was seen in the present series where all 3 patients had renal atrophy at the time of diagnosis of genitourinary TB.…”

“…4 This is when bacilli are shed into the urine spreading TB antegradely to the urothelium of the renal pelvis, ureter, bladder and adjacent genital organs. 4 Often, the involved organs may be irreversibly damaged at the time of presentation as was seen in the present series where all 3 patients had renal atrophy at the time of diagnosis of genitourinary TB. In addition, the first 2 patients had ureteral involvement.…”

“…However, the culture takes 6 to 8 weeks to grow and it has a false negative rate as high as 20%. 4,5 Therefore, at least 3 first morning midstream urine samples are advised to isolate the organism. 6,8 In addition, patients need to be off antibiotics at the time of urine collection since antibiotics may inhibit mycobacterial growth in culture.…”

“…A special acid-fast bacterial culture is required, taking up to 8 weeks for Mycobacterium tuberculosis to grow, with a false negative rate as high as 20%. 4,5 Imaging findings are also non-specific and may even further delay diagnosis. 6 The astute clinician must have a high degree of suspicion for genitourinary TB in patients presenting with non-specific symptoms, culture-negative pyuria, and for whom imaging studies seem atypical.…”

The impact of tuberculosis and chemotherapy on female reproductive health

“…Туберкулезная инфекция распростра-няется по женскому организму лимфогематогенным пу-тем в период наибольшей активации специфического процесса. Мочеполовой тракт является распространен-ной локализацией внелегочного туберкулеза (14-41% в его структуре) [17]. У большинства женщин имеется при-обретенный клеточный иммунитет, который существенно тормозит размножение бактерий и сдерживает образова-ние микроскопических гранулем.…”