[Dynamics of the structure of renal tuberculosis over 20 years].

BACKGROUND: Tuberculosis is a serious medical and social problem that does not lose its importance, despite all the advances in pharmacology and surgery. Diagnosis of urogenital tuberculosis (UGTB), as a rule, is delayed due to low index of suspicion to tuberculosis and the absence of pathognomonic symptoms. AIM: Determining the change in the ratio of clinical forms of renal tuberculosis from 1999 to 2020. MATERIALS AND METHODS: A retrospective cohort comparative non-interventional study on the spectrum of the incidence of extrapulmonary tuberculosis (EPTB) was carried out. Among all 13852 extrapulmonary tuberculosis patients which were diagnosed from 1999 to 2020, patients with renal tuberculosis were selected, and the spectrum of their clinical forms in three periods was analyzed: 1st period 1999-2004 (1155 patients), second period 2005-2014 (2657 patients), and the third period 2015-2020 (671 patients). The clinical features of nephrotuberculosis in 88 patients was also estimated. RESULTS: Over the 20 years of the analyzed period, the number of patients with UGTB decreased by 80.6%; for the year of the COVID-19 pandemic, this figure fell by another third. In the first period, destructive complicated forms of nephrotuberculosis prevailed (922 patients - 79.8%), while the so-called "minor forms" were diagnosed in 233 patients (20.2%). In the second period, the situation was statistically significantly more favorable: the proportion of destructive and complicated forms of renal tuberculosis decreased to 43.8% (1124 patients), "small forms" were diagnosed in 1443 patients (56.2%). In the third period, destructive and complicated forms of nephrotuberculosis were diagnosed in 531 patients (77.6%), and the proportion of "small forms" in comparison with the previous period decreased by half, to 22.4%. Analysis of the clinical features of renal tuberculosis, depending on the prevalence of the destruction, showed that an asymptomatic course is possible, and pain, dysuria, intoxication and renal colic are present with different frequencies, and the clinical picture of tuberculosis of the renal parenchyma differs significantly from the clinical picture of tuberculous papillitis, cavernous nephrotuberculosis and symptoms of renal tuberculosis as whole. CONCLUSION: Currently, there is no screening on urogenital tuberculosis at all. Patients are diagnosed by referral, with a long history, after receiving multiple courses of antibacterial treatment; mainly through the pathomorphological examination of the operating material. Thus, a sharp decrease in the proportion of UGTB patients does not mean the disappearance of tuberculosis of this localization, but only states the tragic defects in timely diagnosis and low index of suspicion of medical doctors in relation to UGTB.

Identifying risk factors for chronic kidney disease stage 3 in adults with acquired solitary kidney from unilateral nephrectomy: a retrospective cohort study.

BACKGROUND: We aimed to examine the risk factors for chronic kidney disease (CKD) stage 3 among adults with ASK from unilateral nephrectomy. METHODS: We retrospectively collected data from adult patients with ASK between January, 2009 and January, 2019, identified from a tertiary hospital in China. The clinical data were compared between patients who developed CKD stage 3 and those who did not develop CKD stage 3 during follow-up. RESULTS: In total, 172 patients with ASK (110 men; median 58.0 years) were enrolled, with a median follow-up duration of 5.0 years. During follow-up, 91 (52.9%) and 24 (14.0%) patients developed CKD stage 3 and end-stage renal disease, respectively. Multiple regression analyses showed that age (odds ratio [OR] 1.076, 95% confidence interval [CI] 1.039-1.115, p < 0.001), diabetes (OR 4.401, 95% CI 1.693-11.44, p = 0.002), hyperuricemia (OR 2.733, 95% CI 1.104-6.764, p = 0.03), a history of cardiovascular disease (CVD) (OR 5.583, 95% CI 1.884-18.068, p = 0.002), and ASK due to renal tuberculosis (OR 8.816, 95% CI 2.92-26.62, p < 0.001) were independent risk factors for developing CKD stage 3 among patients with ASK. CONCLUSIONS: Regular follow-up of renal function is needed among adult patients with ASK. Optimal management of diabetes, hyperuricemia, and CVD may reduce their risk of CKD stage 3, especially among those that undergo unilateral nephrectomy for renal tuberculosis.

[Nephrotuberculosis and urolithiasis].

INTRODUCTION: Urolithiasis and nephrotuberculosis, due to the similarity of the radiographic patterns, share the same differential diagnosis list. The study aimed to analyze the incidence of co-occurrence of nephrotuberculosis and urolithiasis and to determine the impact of urolithiasis on the clinical course of renal tuberculosis. MATERIAL AND METHODS: This open cohort retrospective study comprised 843 patients with renal tuberculosis and 245 patients with urolithiasis. 1088 medical records were analyzed to identify cases with co-occurrence of these two diseases and determine the clinical presentation of renal tuberculosis, urolithiasis, and the comorbid state. Also, patients with pulmonary tuberculosis (44), urogenital tuberculosis (17), and chronic nonspecific pyelonephritis (12) were tested for serum concentration of total calcium and phosphorus. RESULTS: Of 843 patients with renal tuberculosis, 39 (4.6%), had concomitant nephrolithiasis. The combination of urolithiasis with nephrotuberculosis manifested by more severe symptoms; these patients had a more than two-fold risk of tuberculosis recurrence. Except for the incidence of renal colic and dysuria, the clinical manifestations of urolithiasis and nephrotuberculosis did not differ statistically significantly. Prolonged infectious and inflammatory process in the kidneys resulted in an increase in the excretion of oxalates, which was more pronounced in patients with nonspecific pyelonephritis (p<0.05). A three-month course of antituberculosis chemotherapy resulted in a 36.2% increase in the excretion of oxalates in patients with urotuberculosis (p<0.05). Excretion of uric acid also significantly increased after a three-month intake of antituberculosis drugs. CONCLUSION: In our study, the incidence of concomitant urolithiasis and urogenital tuberculosis was low (4.6%), but comorbidity significantly complicated the clinical course of the disease and worsened the prognosis of nephrotuberculosis. Antituberculosis polychemotherapy increases the risk for formation of urinary stones. Prevention of urolithiasis in patients with urogenital tuberculosis warrants further investigation.

Compulsory notification at skilled nursing facilities.

INTRODUCTION:: Notifiable diseases (NDs) encompass conditions of high clinical severity and/or contagious. Being closed communities, long-term care facilities (LTCF) are places that deserve attention on their own, but one might be left wondering: what is the reality of NDs at Brazilian LTCFs? OBJECTIVE:: To determine the prevalence and type of NDs at large LTCF. METHOD:: Active search for NDs conducted by the Hospital Infection Control Committee (HICC) in 459 beds. Due to the low turnover of patients, the monthly list kept by the HICC on NDs was analyzed. Data were grouped into males and females, and into elderly (age ≥ 60 years) and non-elderly (age ≤ 59 years). RESULTS:: 31 diseases in 29 patients (6.9% of all inpatients - 19 males and 10 females): 23 cases of hepatitis C, five of hepatitis B, two of human immunodeficiency virus (HIV), and one case of renal tuberculosis. One patient with hepatitis B and another HIV-positive also had hepatitis C. There was no statistical significance in the comparison of the two groups with the total number of other institutionalized patients - by age and gender - for total number of NDs and cases of hepatitis C (p>0.05). CONCLUSION:: Chronic NDs and those requiring chronic treatment observed in this study suggest that Brazil needs more studies to define the dynamics of these diseases at LTCFs.

Compulsory notification at skilled nursing facilities / Notificação compulsória em instituição asilar

Summary Introduction: Notifiable diseases (NDs) encompass conditions of high clinical severity and/or contagious. Being closed communities, long-term care facilities (LTCF) are places that deserve attention on their own, but one might be left wondering: what is the reality of NDs at Brazilian LTCFs? Objective: To determine the prevalence and type of NDs at large LTCF. Method: Active search for NDs conducted by the Hospital Infection Control Committee (HICC) in 459 beds. Due to the low turnover of patients, the monthly list kept by the HICC on NDs was analyzed. Data were grouped into males and females, and into elderly (age ≥ 60 years) and non-elderly (age ≤ 59 years). Results: 31 diseases in 29 patients (6.9% of all inpatients - 19 males and 10 females): 23 cases of hepatitis C, five of hepatitis B, two of human immunodeficiency virus (HIV), and one case of renal tuberculosis. One patient with hepatitis B and another HIV-positive also had hepatitis C. There was no statistical significance in the comparison of the two groups with the total number of other institutionalized patients - by age and gender - for total number of NDs and cases of hepatitis C (p>0.05). Conclusion: Chronic NDs and those requiring chronic treatment observed in this study suggest that Brazil needs more studies to define the dynamics of these diseases at LTCFs.

Resumo Introdução: Doenças de notificação compulsória (DNC) abrangem quadros de alta gravidade clínica e/ou de contágio. Sendo comunidades fechadas, instituições de longa permanência para idosos (ILPI) são locais que merecem atenção quanto a elas. Mas qual seria a realidade das DNC em ILPI brasileiras? Objetivo: Determinar prevalência e tipo de DNC em ILPI de grande porte. Método: Busca ativa de DNC pela Comissão de Controle de Infecção Hospitalar (CCIH) em 459 leitos. Em razão da baixa rotatividade de pacientes, analisou-se lista mensal da CCIH sobre DNC. Dividiram-se os dados entre homens e mulheres e entre idosos (idade ≥ 60 anos) e não idosos (idade ≤ 59 anos). Resultados: 31 doenças em 29 pacientes (6,9% do total de internados - 19 homens e 10 mulheres): 23 casos de hepatite C, cinco de hepatite B, dois de positividade sorológica ao vírus da imunodeficiência humana (HIV) e um caso de tuberculose renal. Um paciente com hepatite B e outro com HIV positivo eram também portadores de hepatite C. Não houve significância estatística quando foram comparados os dois grupos com o total dos outros internados - por idade e gênero - pelo total de DNC e nos casos de hepatite C (p>0,05). Conclusão: Pesquisa em 15/11/2008 no portal http://www.scielo.br/não detectou casuísticas em ILPI, exceto por revisões sobre tuberculose. DNC de caráter e/ou tratamento crônico observadas neste estudo sugerem a necessidade de maior número de publicações para definir a dinâmica dessas doenças em ILPI brasileiras.

Gross Hematuria Is More Common in Male and Older Patients with Renal Tuberculosis in China: A Single-Center 15-Year Clinical Experience.

OBJECTIVES: This study aimed to investigate the clinical features of renal tuberculosis and identify the age- and gender-related differences. METHODS: A total of 419 patients at the Peking University First Hospital from January 2000 to July 2015 were retrospectively reviewed. Data on demographic characteristics, clinical presentation, complications, laboratory results, radiologic imaging, surgical procedures, and pathology features were collected and compared between genders and 3 different age groups (under 40 years, 41-60, years and over 60 years). RESULTS: The most common local presentations were lower urinary tract symptoms (65.2%), flank pain (37.9%), and gross hematuria (26.3%). Constitutional symptoms were also observed in 38.9% of the patients. Gross hematuria was more common in male patients (32.2%) and older patients (45.5%). Flank pain was more common in female patients (43.6%). Patients younger than 40 years of age had lower frequencies of calcification of the urinary tract (22.2%) and kidney atrophy (4.2%) in CT. In the postoperative pathological reports, atrophy (35.9%) and fibrosis (38.5%) were found to be significantly more common in older patients. CONCLUSIONS: While gross hematuria is more prevalent in older patients and male patients, flank pain is more common in female patients. Radiological and pathological features including calcification of the urinary tract, fibrosis, and kidney atrophy are more common in older patients.

Evaluation of extra pulmonary tuberculosis in Bangladeshi patients.

This is a retrospective study of 200 cases of Extra Pulmonary Tuberculosis (EPTB) and this study was conducted from January 2010 to July 2011 at Sheheed Ziaur Rahman Medical College Hospital and TB clinic, Bogra, Bangladesh. Data were collected from the Hospital records on demographics, clinical, laboratory and treatment out come status. The incidence of EPTB was high in 16-45 years age group (55%), mean age was 35.67±14.6 years and predominated in Female patients (60%). Extra pulmonary Tuberculosis (EPTB) still constitutes an important clinical problem in Bangladesh. The objective of this study was to evaluate the demography and features of patients with EPTB in our high burden tuberculosis country. Lymph nodes are the most common site of involvement (50%) followed by tubercular pleural effusion (15%) and virtually every site of the body can be affected by tuberculosis. Since the clinical presentation of EPTB is atypical, tissue samples for the confirmation of diagnosis can sometimes be difficult procedure and conventional diagnostic method have a poor yield, so the diagnosis is often delayed. EPTB constitutes about 15-20% of all cases of TB patients and it is more common in low socio-economic group (60%) Biopsy and/ or surgery, FNAC is required to procure tissue samples and pus and/or aspirated fluids are required for diagnosis and for managing complications. The EPTB usually responds to standard anti tubercular drug regimen.

[Epidemiology and clinical features of renal tuberculosis: 239 cases report].

OBJECTIVE: To study the changes in the status of genitourinary tuberculosis, especially in renal tuberculosis. METHODS: In the study, 239 cases of renal tuberculosis from 2000 to 2010 were retrospectively reviewed. The patients with 3 or more than 3 kinds of common clinical manifestations of genitourinary tuberculosis were regarded as typical group (145 cases), and otherwise, as atypical group (94 cases). RESULTS: The cases of renal tuberculosis constituted 0.89% of the urological inpatients in a duration of 11 years from 2000 to 2010. The incidence rates were higher in the 40-60 years old patients (45.61%). 48% of the patients were farmers or the unemployed. The most common clinical manifestations included frequency (151 cases), urgency (124 cases), odynuria (120 cases), flank pain (97 cases), and hematuria (76 cases). However, flank pain (34.04%) turned into the main complaint of the atypical group. We found that 125 cases had a history of pulmonary tuberculosis or an abnormal chest radiography, 30 patients were diagnosed as contracted bladder (typical group/atypical group: 26/4, P<0.05), and 20 patients (8.4%) were diagnosed as contralateral hydronephrosis. And 198 cases were examined by acid-fast stain, with a positive diagnostic rate of 47.98%. Also 202 cases of the 205 patients who had an ultrasonography had an abnormal outcome and 135 cases of them were definitively diagnosed. Surgical treatments were performed among almost all the patients, while 21 cases only had antituberculosis drugs. CONCLUSION: Socio-economic issues still affect the status of genitourinary tuberculosis. The history of pulmonary tuberculosis or an abnormal outcome of chest radiography can provide an important clue during the diagnostic process. Acid-fast stain and ultrasonography remain as effective screening tests. Though the treatment with antituberculosis drugs has become the "mainstream", the surgical treatment is needed for advanced renal tuberculosis.

Renal tuberculosis in the modern era.

Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis. The disease remains as an important public health problem in developing countries. Extrapulmonary TB became more common with the advent of infection with human immunodeficiency virus and by the increase in the number of organ transplantation, which also leads to immunosuppression of thousand of persons. Urogenital TB represents 27% of extrapulmonary cases. Renal involvement in TB can be part of a disseminated infection or a localized genitourinary disease. Renal involvement by TB infection is underdiagnosed in most health care centers. Most patients with renal TB have sterile pyuria, which can be accompanied by microscopic hematuria. The diagnosis of urinary tract TB is based on the finding of pyuria in the absence of common bacterial infection. The first choice drugs include isoniazide, rifampicin, pirazinamide, ethambutol, and streptomycin. Awareness of renal TB is urgently needed by physicians for suspecting this disease in patients with unexplained urinary tract abnormalities, mainly in those with any immunosuppression and those coming from TB-endemic areas.

[Tuberculous peritonitis: experience in Treviso from 2000 to 2010]. / Peritonite tubercolare: esperienza di Treviso nel decennio 2000-2010.

Peritonitis is an uncommon localization of tuberculosis in Italy; diagnosis and treatment are often difficult and delayed. Fifteen cases, followed by Infectious Diseases Department in Treviso from 2000 to 2010, are described. Mortality and long term complications were absent, in contrast with medical literature. The usefulness of steroid therapy is still uncertain. Other sites of infection were present in 60 percent of patients (pulmonary TB in 47%), urging the clinician to examine the case promptly to determine infectiousness status.

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.

[Bacteriological diagnosis of renal tuberculosis: an experience at the regional tuberculosis laboratory in Córdoba Province, Argentina]. / Diagnóstico bacteriológico de tuberculosis renal: experiencia del Laboratorio Regional de Tuberculosis de la provincia de Córdoba.

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.

Tuberculous orchiepididymitis during 1978-2003 period: review of 34 cases and role of 16S rRNA amplification.

Genitourinary tuberculosis was diagnosed in 543 patients in Spanish hospital from 1978 through 2003. Of the 371 male 34 (9.2%) had orchiepididymitis. Mean age was 52.7 years and the presenting symptom was scrotal swelling and/or pain. Over 50% of cases involved the right ovotestis. Associated renal tuberculosis and active disease in extraurological organs presented in 64% and 19.2% of cases, respectively. Diagnosis was established by culture of Mycobacterium tuberculosis recovery from urine and/or purulent scrotal exudate. Genomic amplification techniques aided the diagnosis in 8 patients. Treatment was rifampin, isoniazide, and pyrazinamide or ethambutol. Eight patients required combined medical and surgical treatment.

[Surgical treatment of nephrotuberculosis in the present-day epidemiological situation].

The article presents data on the structure of operative interventions and assessment of the role of an early kidney decompression in management of renal tuberculosis complicated by urethritis. It was found that such eradicative techniques as nephrectomy and nephruretherectomy still prevail. Early drainage of the kidney for its decompression allows preservation of the kidney and following reconstructive surgery in 70.6% of cases. The number of early and later complications considerably decreased.

Radiological findings in renal tuberculosis: a report from northwest of Iran.

Tuberculosis (TB) of the kidney and urinary tract has non-specific symptoms and is easily overlooked. We performed this retrospective study to analyze different findings on excretory urography (IVP) of patients with renal TB. The IVP slides of 25 patients (14 females/11 males, age range 12-63 years) with renal TB diagnosed over a 20-years period were studied for the presence of characteristic findings. They included: renal parenchymal mass, autonephrectomy, hydronephrosis, ureteral stricture and dilatation, and bladder involvement and fibrosis. In our study, the most common findings were ureteral stricture and dilation (13/25, 52%), bladder involvement 13/25 (52%), autonephrectomy 12/25 (48%) and renal parenchymal calcification 10/25 (40%). The most common combined pattern was ureteral stricture-dilation with contralateral autonephrectomy and bladder irregularities. We conclude that kidney TB remains undiagnosed until the advanced stages and awareness about the IVP imaging pattern could help in early diagnosis of this entity.

[Organization of early detection of nephrotuberculosis in risk groups].

The present capacities of early detection of nephrotuberculosis in risk groups are considered in detailed. For this, a total of 1150 patients, including 650 from general health care facilities and 500 from tuberculosis dispensaries, were examined. Comprehensive examination patients from risk groups revealed nephrotuberculosis in 135 (11.7%) patients. The most patients with nephrotuberculosis were identified in the tuberculosis dispensaries (60.7%) whereas these amounted to 39.3% in the general health care facilities. The data of medical history, renal ultrasonography, and urinalysis for Mycobacterium tuberculosis play an important role in the early detection of nephrotuberculosis. The leading techniques in detecting patients with nephrotuberculosis in the risk groups are currently X-ray and ultrasonographic studies that identify 60.5 and 55.7% patients, respectively. The developed clinical, laboratory, and ultrasonographic studies in the tuberculosis dispensaries and general health care facilities considerably enhance the diagnostic capacities of detecting nephrotuberculosis.

[Concomitant tuberculosis of the lung and kidneys: the clinical and diagnostic features].

Three groups of patients were examined. These included: (1) 134 patients with concomitant tuberculosis of the lung and kidneys; (2) 103 patients with pulmonary tuberculosis; (3) 65 patients with renal tuberculosis. It was established that conventional clinical, X-ray tomographic, and laboratory studies assisted in diagnosing concomitant tuberculosis of the lung and kidney in 42.5% of the patients and difficulties ensued in the diagnosis of 57.5% of cases. A comprehensive study involving pulmonary X-ray tomography, X-ray contrast urography, renal ultrasound scanning, sputum and urinary test for Mycobacterium tuberculosis, immunoassay, and immunoprovocative test with 20 TE of PPD enhanced the efficiency of diagnosis of this disease uo to 92%.

Urinary tuberculosis: ten years' experience.

In this study of 26 patients, clinical features diagnosed as urinary tuberculosis in our nephrology and urology clinics between 1993 and 2002 were investigated retrospectively. Fifteen patients (52%) were male, and mean age was 43.5 (18-71). Twenty percent of the patients were asymptomatic. Frequency-dysuria (46%), flank pain (33%), and macroscopic hematuria (12%) were presenting symptoms. Physical examination was not diagnostically helpful in most patients. Hematuria and/or pyuria were detected in 80% of the patients. Eleven patients had positive urine cultures of Mycobacterium tuberculosis (42%), and 7 patients had positive smears (25%). Definitive diagnosis of urinary tuberculosis was established microbiologically in 15 patients (58%) and histopathologically in 11 patients (42%). Tuberculin skin test was positive in 60% of the patients. Eight patients had an abnormal chest roentgenogram. Hydronephrosis (majority bilateral) in 11 patients (42%), contracted bladder in 9 patients (34.6%), and renal calcification in 6 patients (23%) were detected. Two patients also had genital tuberculosis (epididymoorchitis). Although only medical treatment was applied in 13 patients for 9 months, in the rest of the patients medical therapy plus surgical intervention was carried out. End-stage renal failure developed in one patient who died on hemodialysis. Renal functions had decreased moderately in two other patients. In conclusion, the diagnosis of urinary tuberculosis was able to be established after the obstructive complications and functional losses were developed in a fair number of cases. Surgical treatment was carried out in half the patients. Urinary tuberculosis should be taken into consideration because early diagnosis and treatment is very important for the presenting of irreversible sequelae.

[Assessment of long-term renal function after nephrectomy. Study of 53 patients]. / Estudio de la función renal a largo plazo en 53 pacientes con nefrectomía por diversas causas.

BACKGROUND AND OBJECTIVE: Patients with unilateral nephrectomy maintain the remaining kidney function over time, as it has been described in healthy kidney donors. PATIENTS AND METHOD: We performed a cross-sectional study of 53 patients who were followed 5 or more years after nephrectomy. Serum creatinine, BUN, Glomerular Filtration Rate (GFR) (24 hours urine collection and Cockcroft formula), microalbuminuria, proteinuria, Body Mass Index and the annual loss rate of renal function were measured or calculated over the follow-up period. We retrospectively considered the presence of risk factors like diabetes, hypertension, microalbuminuria, dyslipemia, smoking habit, obesity and ACE inhibitors or angiotensin-receptor antagonists treatment. We divided our patients into two groups: group I (normal or mild renal failure: GFR > 50 cc/min and or serum creatinine < 1.4 mg/dL) and group II (moderate or severe renal failure). RESULTS: The main cause of nephrectomy was renal tuberculosis, followed by lithiasis and pyonephrosis. In addition, 7.5% of patients were kidney donors. At the time of study, 22.7% had diabetes, 60.4% hypertension and 39.6% were obese. The mean age was 60 years (37 years at the moment of nephrectomy). The GFR final mean was 53.6 cc/min (58.8 cc/min by Cockcroft formula). The mean renal function loss rate was 1 cc/min/year. 35% of the patients had moderate or severe kidney failure and were included in group II; 32% had proteinuria and 56.6% had abnormal microalbuminuria. The univariate risk factors analysis for the development of renal failure showed inter-group statistical significative differences in current age, nephrectomy age, microalbuminuria, proteinuria, and hypertension prevalence (p = 0.008). With regard to the progression rate, we found a significant correlation with final microalbuminuria (r = 0.358, p = 0.03). Current age and final proteinuria were found to be significant risk factors in the multivariate analysis. CONCLUSIONS: A high prevalence of renal insufficiency was found among patients with unilateral nephrectomy, which is mainly related to age and proteinuria. The renal function loss rate is slow and is influenced by microalbuminuria.

[Combined clinical forms of pulmonary and extrapulmonary tuberculosis]. / Poiednannia klinichnykh form lehenevoho ta pozalehenevoho tuberkul'ozu.

60 medical reports of patients with combination of pulmonary and urogenital organs tuberculosis were analyzed. Our study has shown that with heightening sickness rate of all forms of tuberculosis including pulmonary tuberculosis one can notice a slight rise of extrapulmonary tuberculosis. It can be explained first of all by difficulty in diagnosing extrapulmonary tuberculosis and absence of professional watchfulness to a possibility of combination of pulmonary and extrapulmonary tuberculosis. For example, in 45.3% of all cases with no positive effect of antibiotic therapy wasn't taken into account additional diagnostic methods for finding etiologic agent of the pathological process (Mantu test with 2 TU, Koh test with 50-100 TU, biological test, plan X-ray film of lungs, ultrasonic diagnostics of visceras, urine inoculation for MBT before treatment) and patients often were found with advanced tubercular process as in lungs so in urogenital organs.