Renal tuberculosis

RENAL TUBERCULOSIS:

v  Tuberculosis  is a disease that normally affects the lungs but it can affect many other body organs such as the kidney

v  Common form of non pulmonary tuberculosis

v  Also called nephrotuberculosis , renal tuberculosis or tuberculosis of the kidney.

v  Tuberculosis of uro-genital organs is noted in 7% (apprx) of patients suffering from tuberculosis

Causative organism:

—  Causative agent is most commonly is Mycobacterium tuberculosis but bovine tuberculosis may be involved.

—  Other species within the genus Mycobacterium are free-living environmental saprophytes and are commonly found in water, hence it readily contaminate the lower urethra and external genitalia and, thus, often are isolated from urine samples( may cause disease in immunosuppressed individuals , including recipients of renal transplants )

Pathogenesis:

—  If a tuberculous lesion in the lung gains access to the vascular system by erosion of the wall of a vessel, usually a vein, then emboli containing organisms may be disseminated throughout the body

—   However, the bacilli have stringent growth requirements and generally tend to proliferate only in a small number of sites, including the kidney, epididymis, fallopian tube, bone marrow, and brain, particularly the hindbrain

—  In most cases, at the time of presentation there is no evidence of active pulmonary disease suggesting that renal involvement occurs as a result of reactivation after a period of dormancy (a long latent period after the initial pulmonary tuberculosis infection)

—  Following an initial, acute, inflammatory response with polymorphonuclear leukocytes, a chronic inflammatory process develops with macrophages and the subsequent development of granulomas with lymphocytes, and fibroblasts

Symptoms:

—  No early symptoms (Many patients present with lower urinary symptoms typical of  bacterial cystitis)

—  kidney inflammation

—  Pyelonephritis

—  Fever

—  Chills ,Shivering

—  Loss of appetite

—  Weight loss

—  Malaise

—  Kidney pain