Transitional cell carcinoma of the renal pelvis masquerading as renal tuberculosis

We report a case of transitional cell carcinoma of the right renal pelvis mimicking the signs, symptoms and radiological findings of renal tuberculosis (TB). She had been diagnosed initially for urinary tract infection and radiological diagnosis initially was more towards renal TB and urine cytology and cultures were normal. Specific investigations for tuberculosis all showed negative results. But as neoplasia could not be ruled out by ureterorenoscopy due to presence of multiple ureteric strictures, decision was taken for an exploratory surgery. During surgery it was found that there was a tumour in the upper pole of kidney involving the renal pelvis and was found to be papillary transitional cell carcinoma on histopathological examination.

The imaging study on morphological differences of renal tuberculosis and non-tuberculous obstructive hydronephrosis / 中华放射学杂志

Objective To investigate the value of morphological features in differentiating between tuberculous hydronephrosis and non-tuberculous obstructive hydronephrosis.Methods The abdominal enhanced-CT examination data of 33 patients with renal tuberculosis and 37 patients with non-tuberculous obstructive hydronephrosis were retrospectively collected.All patients were examined in Peking University First Hospital from September 2009 to November 2016 and confirmed by surgical pathology or clinical manifestation.The longest diameter and largest area of all dilated calices,the anteroposterior longest diameter and the area of renal pelvis at the renal hilum level were measured.The standard deviation of dilated calyx's longest diameter and largest area in each case,the ratio of the mean value of dilated calyx's longest diameter to the anteroposterior longest diameter of renal pelvis and the ratio of the mean value of dilated calyx's largest area to the area of renal pelvis were calculated.These data were compared between the two groups with the t test.Based on the ratio of dilated calyx's longest diameter and largest area to those of renal pelvis,receiver operating characteristic (ROC) curves were used to calculate cut-off values for diagnosis of tuberculous hydronephrosis.Results The standard deviation of dilated calyx's longest diameter and largest area were significantly different in the renal tuberculosis group and the non-tuberculosis group (P＜0.01).The ratio of dilated calyx's longest diameter and largest area to those of renal pelvis of tuberculosis group were significantly larger than those of non-tuberculous group (P＜0.01).ROC analysis of the ratio of dilated calyx's longest diameter to that of renal pelvis showed that the area under the curve was 0.87 (95％ confidence interval 0.77-0.94),the best cut-off point was 0.73,with 81.8％ sensitivity (27/33) and 81.1％ specificity (30/37).ROC analysis of the ratio of dilated calyx's largest area to that of renal pelvis,the area under the curve was 0.90 (95％ confidence interval 0.80-0.95),the best cut-off point was 0.42,with 81.8％ sensitivity (27/33) and 86.5％ specificity (30/37).Conclusions In tuberculous hydronephrosis,the dilatation of calices is more obvious than renal pelvis,and the size of dilated renal calices is remarkably different.In non-tuberculous obstructive hydronephrosis,the dilatation of renal pelvis is more obvious than calices,and the size of dilated renal calices is similar.The morphological differences are helpful in differentiating tuberculous and non-tuberculous hydronephrosis.

Chronic kidney disease related to renal tuberculosis: a case report

Abstract: Genitourinary tuberculosis (TB) is the third most common form of extrapulmonary TB. A 34-year-old man with severe kidney function loss secondary to renal TB initially presented with urinary symptoms, including dysuria and polacyuria. The diagnosis was based on clinical history and laboratory tests; the urinalysis revealed acid-fast bacilli. The patient's condition stabilized after beginning TB-specific treatment, but the right kidney function loss persisted. Renal TB can lead to irreversible loss of renal function. As such, renal function should be considered in all patients from TB-endemic areas who present with urinary symptoms and whose urine cultures are negative for common pathogens.

Dual Time Point 18F-FDG PET/CT Imaging Identifies Bilateral Renal Tuberculosis in an Immunocompromised Patient with an Unknown Primary Malignancy

18F-FDG PET/CT imaging is an established imaging modality for cancer staging and response assessment. Its role in identifying infective and inflammatory pathologies from malignancy is debated. Dual time - point imaging is a refined technique used to overcome this interpretational dilemma. We present a 59 year old male with an unknown primary malignancy who was referred for a 18F-FDG PET/CT imaging. Images revealed primary lung malignancy with co existing bilateral renal tuberculosis which otherwise would have gone amiss or would have been considered as metastases.

Psoas Abscess Secondary to Renal Tuberculosis in a Middle-aged Woman

A psoas muscle abscess is a relatively uncommon condition that can present with vague clinical features. With the decreasing prevalence of tuberculosis, psoas abscesses of tuberculous origin are currently rare in developed countries, but are typically caused by tuberculosis of the spine. Here, an unusual case of a psoas abscess secondary to renal tuberculosis in a middle-aged woman is presented. The abscess was successfully treated with percutaneous drainage followed by nephrectomy and additional antituberculous medications.

Review of genitourinary tuberculosis with focus on end-stage renal disease / Revisão acerca da tuberculose genitourinária com foco na insuficiência renal crônica terminal

Tuberculosis (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.

A tuberculose (TB) é um problema atual de saúde pública, persistindo como a causa mais comum de óbito por doenças infecciosas. Estudos recentes indicam que a TB genitourinária é a terceira forma mais comum de doença extra-pulmonar. O diagnóstico da TB renal pode ser suspeito na presença de cistite bacteriana não-específica associada a falha terapêutica ou com exame de urina apresentando leucocitúria persistente na ausência de bacteriúria. Relatamos o caso de um paciente de 33 anos, sexo masculino, que apresentou na admissão insuficiência renal crônica terminal secundária à TB renal, que tinha história prévia de TB pulmonar, com importantes achados radiológicos. O diagnóstico foi baseado nos achados clínicos apesar de todas as culturas terem sido negativas. Tratamento empírico com drogas tuberculostáticas foi iniciado e o paciente evoluiu estável. Foi de alta assintomático, mas sem recuperação da função renal. Ele encontra-se em hemodiálise três vezes por semana. A TB é uma causa importante de doença renal e pode levar à perda irreversível da função renal.

Diagnóstico bacteriológico de tuberculosis renal: experiencia del Laboratorio Regional de Tuberculosis de la provincia de Córdoba

Dada la considerable incidencia de tuberculosis renal entre enfermos con tuberculosis pulmonar, nos propusimos estudiar la frecuencia de esta asociación en pacientes atendidos en centros de salud públicos y privados de Córdoba a lo largo del período 1997-2009. Se tomó en consideración la incidencia según el sexo y las especies del complejo Mycobacterium tuberculosis identificadas. El análisis de 948 muestras de orina de 383 pacientes indicó tuberculosis renal en 24 casos (6,3 %), con presencia mayoritaria de Mycobacterium tuberculosis (95,8 %) y presencia de Mycobacterium bovis en 4,2 % de los casos. La asociación tuberculosis renal-tuberculosis pulmonar activa se encontró en 6 casos. En esta investigación quedó demostrada la importancia del cultivo seriado de muestras de orina y la conveniencia de cultivar en medios sólidos y líquidos. Asimismo, el aislamiento de Mycobacterium bovis pone de relieve la importancia de usar el medio Stonebrink junto con el medio de Lowenstein-Jensen. El medio líquido no tuvo un aporte significativo al diagnóstico de tuberculosis renal; sin embargo, el cultivo de muestras seriadas aumentó la sensibilidad de la detección.

Bacteriological diagnosis of renal tuberculosis: an experience at the Regional Tuberculosis Laboratory in Córdoba province, Argentina. Given the incidence of renal tuberculosis in patients suffering of pulmonary tuberculosis, we seek to study both the frequency of this association in diagnosed cases of renal tuberculosis and the Mycobacterium tuberculosis complex species that were identified (period 1997-2009), observing its incidence by sex, demonstrating the importance of serial culture of urine samples and evaluating the convenience of using solid and liquid media. The analysis of urine samples from 383 patients indicated renal tuberculosis in 24 cases; in most cases, (95.8 %) Mycobacterium tuberculosis complex species prevailed, whereas the presence of Mycobacterium bovis accounted for 4.2 % of the cases. The association of pulmonary and renal tuberculosis was found in 6 cases. The isolation of Mycobacterium bovis indicates the importance of including Stonebrink medium along with Lowenstein- Jensen medium. The liquid medium made no significant contribution to the diagnosis of renal tuberculosis, but indeed, cultivating serial samples increases sensitivity.

Application of double-J catheter in treatment of renal tuberculosis / 第二军医大学学报

Objective: To investigate the therapeutic efficacy of double-J catheter in treatment of renal tuberculosis(TB) and in rescuing the structure and function of the kidney. Methods: Thirty-four patients with renal TB (22 combined with single side hydronephrosis) were divided into 2 groups randomly. Group A were treated with antituberculous therapy and group B with antituberculous therapy combined with pre-treatment with double-J catheter. All 34 patients were followed up for 3 months and were re-examined. Results: The results of B ultrasound, intravenous urogram (IVU), CT and isotope nephrogram were comparable between the 2 groups before treatment, and the results were significantly different between the two groups after 3 months' drug treatment (P<0.05). The results of routine urine tests, ESR and the positive rates of urine ABF were not significantly different between the 2 groups (P<0.05). Nephrectomy was performed in 21 cases, with 15 cases(88.2%) in group A and 6 cases(35.3%)in group B (P<0.05). Conclusion: Pre-treatment with double-J catheter in the diseased side of patients with renal TB can better preserve the structure and function of the kidney, and can help to lower the rate of nephrectomy.

Surgical diagnosis and treatment of renal tuberculosis / 中国综合临床

Objective To study the surgical diagnosis and treatment of renal tuberculosis(TB). Methods The clinical data of 42 cases with renal TB were analyzed retrospectively and the experiences of clinical diagnostic and treatment were summarized. Results Cystic irritation symptoms(78.6% ,33/42)and gross hematuria(64. 3%,27/42)were the most common symptoms in these patients. Abnormal urine were found in 83.3 % cases. Acid-fast stains on urinary sediment were positive in 28.6%(12/42)of cases. The diagnostic accuracy of B-ultrasonicgraphy,IVU,retrograde pyelography and CT examination in these patients were 19.0%(8/42),33.3% (14/42),26.2%(11/42)and 71.4%(30/42)respectively. Among all cases enrolled in the study,6 patients received antiphthisic medicine treatment,3 of them were cured and the other 3 accepted nephrectomy and partial ureterectomy after 6-12 months because of severe renal function impairment 36 cases received surgical treatment. In the 39 cases treated with operation,all of them were proved to carry renal tuberculosis by the postoperative pathological examinations. Conclusions The medical history,urine analysis,image examination should be considered synthetically in the clinical diagnosis of renal tuberculosis. The patients should be followed up closely during antiphthisic treatment period. Seriously damaged or nonfunctioning kidney should be removed promptly.

Diagnosis and treatment of renal tuberculosis / 中华泌尿外科杂志

Objective To discuss the diagnosis and treatment of renal tuberculosis.Methods A retrospective study was made on 96 cases.Results Frequency (51.8%), urgency (37.2%),odynuria (33.4%),lumbodynia (41.0%),and hematuria(48.1%)were the most common symptoms. The diagnostic accuracy of IVU, B-type ultrasonography, CT and biopsy of mucous membrane of urinary bladder were 69.1%,12.5 %,37.5% and 33.3% respectively. 96 cases were given medicine (INH+RFP+PZA or PIA for 6-8 months).38 cases(39.6%)have been cured, while symptoms of 43 cases (44.8%) have been improved. Operation was performed on 15 cases that were ineffective treated by chemical therapy. Conclusions Urine routine, IVP, cystoscopy+biopsy of mucous membrane of urinary bladder provide important information for the diagnosis of renal tuberculosis. INH, REP and EMB or PIA combination therapy yields satisfactory outcome for early cases.

Treatment of renal tuberculosis complicated with active pulmonary tuberculosis / 重庆医科大学学报

Objective:To implove the level of diagnosis and treatment of renal tuberculosis complicated with active pulmonary tuberculosis.MethodsThe diagnosis and treatment of 28 cases with renal tuberculosis complicated with active pulmonary tuberculosis were analyzed.Results:88.2% of patients were negative in PPD test, and 55.6% positive in the sputum acid fast stain. All the patients except 4 received thetreatment of anti-tuberculosis continuosly for 3-6 months before surgery.Conclusion:It is necessary to treat the patients with anti-tuberculosis drugs and improve their immune function before proper surgical treatment.Patients in fair general condition could be operated on 2 weeks after anti-tuberculosis therapy.

Significance of Nephrectomy in Renal Tuberculosis Patients with Negative Urine (AFB) Culture and Asymptomatic Nonfunctioning Kidney / 대한비뇨기과학회지

PURPOSE: The aim of this study was to evaluate the surgical treatment of incidentally detected, asymptomatic, unilateral nonfunctioning tuberculous kidney. MATERIALS AND METHODS: Thirty-three patients with incidentally detected, asymptomatic, unilateral nonfunctioning kidney, negative urine AFB culture and radiologic diagnosis of renal tuberculosis were reviewed. They were divided into three groups: surgical, medical, and observation groups. Twelve patients in the surgical group were nephrectomized at initial diagnosis. Eleven patients in the medical group received anti-tuberculous medication with isoniazid, rifampin, and pyrazinamide for 4 months. Ten patients in the observation group remained under observation. RESULTS: There was no evidence of decreased renal function or recurrence of renal tuberculosis in the surgical and medical groups. Pathologic confirmation of renal tuberculosis was obtained in all nephrectomy patients. The follow-up loss rate of the surgical group (7.7%) was lower than that of the other groups (p<0.05). CONCLUSIONS: Nephrectomy is more acceptable than either medicine or observation. (1) Because preoperative chemotherapy was not justified in the case of negative urine AFB culture, pathologic confirmation was necessary. (2) Nephrectomy associated morbidity was quite low. (3) The follow-up loss rate of the surgical group was lower than that of the other groups. Short course anti-tuberculous medication should be administered after nephrectomy.

Renal Tuberculosis CT Diagnosis and Mis-diagnostic Analysis / 实用放射学杂志

Objective To evaluate the CT values in diagnosis of renal tuberculosis. Methods 26 cases were collected , the CT findings of renal tuberculosis were analysed and compared with the data of operation-pathology and clinical followed up. Results Of 26 cases, 22 cases diagnosed by CT as renal tuberculosis of one side were confirmed by operation-pathology but one (pseudaneurysm). Bilateral renal tuberculosis and renal cysts were diagnosed in 2 cases respectively by CT, while these 4 cases were confirmed as tuberculosis by other auxiliary checking methods and followed-up. The multiple tuberculoses cavities appeared as a petal-shape low-density area and other untypical signs on CT. The single cavity only showed as a low-density area should be distinguished with cystonephrosis. At early renal tuberculosis, a great quantity of effusion beneath the perinephrium was the only sign on CT.Conclusion CT scan has a special value for diagnosis renal tuberculosis. Typical renal tuberculosis can be made closely combining with the clinical information.

MRU features of renal tuberculosis in relation to pathologic changes / 中华泌尿外科杂志

Objective To evaluate the diagnostic value of MR urography(MRU) in the diagnosis of renal tuberculosis. Methods MRU features of 18 cases of renal tuberculosis,nonvisualized or poorly visualized in IVU,were analyzed and compared with pathologic findings. Results MRU provided high-resolution images of the kidneys and upper urinary tract in all patients.MRU features of renal tuberculosis and corresponding pathologic changes were summarized. Conclusions MRU has a great value in diagnosing renal tuberculosis when the kidneys are nonvisualized or poorly visualized in IVU.It can provide diagnostic evidence and is helpful with choice of the therapeutic strategy.

Endocalicotomy for the management of the tuberculous renal caliceal stricture / 대한비뇨기과학회지

The stricture of the calyx, pelvis or ureter due to renal tuberculosis had been managed like nephrectomy, partial nephrectomy, ureteroileoneocystoplasty or even pancaliceal-ileoneocystoplasty. To salvage the renal parenchyme and to treat the tuberculous renal caliceal strictures, percutaneous endocalicotomy with or without endopyelotomy was performed in 10 cases from Aug. `90 to Jan. `92. The sites of stricture were mainly upper calyx in 6 cases and lower in 4. A cold knife was used to incise the stricture and a stenting 2-sectioned(14 Fr.) endopyelotomy catheter was retained for 6 to 8 weeks. Postoperative intravenous pyelography revealed marked shrinkage of the dilated calyx in 7 cases. moderate in 1 and no change in 2(success rate, 80%). In failed 2 cases, 1 cases was performed partial nephrectomy and the other was following. There was no significant complications except 1 case of upward migration of D-J catheter. In conclusion, endocalicotomy is safe, less invasive, successful (in cases that guide wire could pass) and parenchyme preserving procedure. The retregrade pyelography is mandatory just before the surgery because stricture can be progressed during Anti-Tbc chemotherapy.

A clinical comparison of the urine acid-fast bacilli culture results in renal tuberculosis / 대한비뇨기과학회지

A clinical comparison of the urine acid-fast bacilli culture results with 82 cases of renal tuberculosis patients was made who were admitted to the Department of Urology, Wonju Christian Hospital during the period from January, 1982 to December, 1989. The urine acid-fast bacilli culture positive rate was 37.8%. The glucose and protein contents in urine of culture positive group were 47.6 mg% and 56. 8mg% and they were higher than those of culture negative group's 29.4 mg% and 27.7 mg%. The most frequent symptom in the urine acid-fast bacilli culture positive group was voiding symptoms (48%), and flank pain was the most frequent symptom(48%) in the urine acid-fast bacilli culture negative group. Non visualized kidney or delayed visualization was the main excretory urography findings in 41% of the culture positive and 74% of the culture negative group. In early renal tuberculosis the radiologic changes are minimaland the culture positive rate is high and the main complaints of patients are bladder irritation symptoms, later the disease progresses and the obstructive symptom appear more frequently and the culture positive rate is low. We concluded that the culture positive rate, excretory urography findings and main symptoms are related with the drainage of urine.

Experience on 11 Cases of New Aspects of Renal Tuberculosis / 대한비뇨기과학회지

The decline in the incidence of renal tuberculosis has not had any conclusive evidence yet in korea, and the disease has not been eradicated completely. The clinical study was made on the 11 inpatients who showed atypical clinical findings of renal tuberculosis at Korea General Hospital, Seoul, Korea, 1982 to 1985. The clear diagnosis of 11 cases was established pathologically at operation. It is suspected that atypical renal tuberculosis will be lead to difficulties in diagnosis.

Application of double-J catheter in treatment of renal tuberculosis / 第二军医大学学报

Objective:To investigate the therapeutic efficacy of double-J catheter in treatment of renal tuberculosis(TB)and in rescuing the structure and function of the kidney.Methods:Thirty-four patients with renal TB(22 combined with single side hydronephrosis)were divided into 2 groups randomly.Group A were treated with antituberculous therapy and group B with antituberculous therapy combined with pre-treatment with double-J catheter.All 34 patients were followed up for 3 months and were re-examined.Results:The results of B ultrasound,intravenous urogram(IVU),CT and isotope nephrogram were comparable between the 2 groups before treatment,and the results were significantly different between the two groups after 3 months'drug treatment(P

The Surgical Treatment of Non-Visualizing Tuberculous Kidney / 대한비뇨기과학회지

A clinical observation was made on 19 cages of nonvisualizing tuberculous kidney, who were admitted to national medical center during the period from January, 1981 to April, 1982. Following results were obtained. 1. Most common age group were from 3rd to 5th decade. 2. Most frequent symptom or complaint was grose hematuria and this was subsided after operation. 3. In laboratory findings, pyuria 178.9% and microscopic hematuria (78.9%) were identified. 4. The most common other site of tuberculosis was lung about 12 cases. 5. In microbiologic study for 24hr urine and caseous material from kidney, following answers were given. 1) 24hr urine AFB smear :+: 8cases Tuberculosis culture :+: 4cases 2) Caseous materiel from kidney AFB smear :+: 10 cases Tuberculosis culture :+: 2cases. 6. R.G.P. was tired in all cases, but could not insert the ureteral catheter due to ureteral stricture in 14 cases. 7. All cases of nonvisualizing kidneys were removed.

A Clinical Observation on Renal Tuberculosis / 대한비뇨기과학회지

A clinical observation was made on 46 cases of renal tuberculosis who were admitted to the Department of Urology, Eul Ji General Hospital, Seoul, Korea, during the period from January 1978 to December 1982. Following results were obtained. 1. The most common symptoms were urinary frequency (47.8%), gross hematuria (43.5%) flank pain (32.6%) and dysuria (21.7%). 2. Tubercle bacilli were demonstrated in 37% of patients by Ziehl-Neelson staining. The most common findings of urine were hematuria (73.9%), Pyuria (54.4%) and proteinuria (32.6%). 3. Excretory urographic findings in 46 cases of renal tuberculosis were non visualization (45.7%), calyectasis (28.3%), delayed visualization (15.2%), ureteral deformity (10.9%). 4. The most common finding of cystoscopy was hemorrhagic patches (44.4%), followed by sealed off ureteral orifice (s) in 30.6%, ulceration and tubercle formation in 25.0%. 5. Patients were managed by chemotherapy only in 47.8%, chemotherapy with nephrectomy in 43.5%, chemotherapy with reconstructive surgery in 8.7%.