KIDNEY TUBERCULOSIS
Tuberculosis of the kidney and urinary tract is caused by the organism Mycobacterium tuberculosis and usually spread from the lungs by way of the bloodstream to the kidneys and other organs of the genito urinary tract. The process of TB generally starts in one of the renal pyramids, ulceration into the kidney pelvis follows. The organisms are carried down with the urine into the bladder so that the bladder is likely to become infected.
TB of the lower genitourinary tract is always 2º to renal TB with the infection having disseminated downward. In the male, the prostate and epididymis may become infected.
[TB of the urinary bladder is an extension of TB of kidney.) this disease gives rise to several small ulcers, the majority of them near the trigone of the bladder.
Clinical Manifestations
At first the symptoms are mild; there is usually a slight At afternoon fever and a loss of weight, & appetite. Increased urinary output that contains considerable pus and yet us acid in reaction [in nearly all other pyurias the urine is alkaline) haematuria [(either microscopic or gross)]. Pain, dysuria and urinary frequency are due to bladder infection
Frequency, nocturia [(signs of bladder irritability)] later manifestations.
Diagnostic Measures
1. Identify TB elsewhere in the body. Inquiry to determine if the Patient has had known exposure to TB.
2. 3 or more clean voided first morning urine specimens are obtained for culture for M. tuberculosis.
Medical Management
Combination of ethambutol, isoniazid and rifampicin used to delay the emergence of resistant organisms: [Shorter course chemotherapy (4 months) has been proven effective in eradicating the organism and in penetrating renal tissue. Since renal TB is a manifestation of a systemic disease, all measures to promote the general health of the person are used.]
Surgical intervention may be necessary to prevent obstructive problems and to remove an extensively diseased kidney -cuts of the blood supply
Patient is counseled about the need for follow up examination (urine cultures, excretory urogram) usually for a period of a year. To prevent metastasis
Treatment will need to be re-instituted if a relapse occurs genito urinary tract.
Complications
Urethral stenosis or bladder contractors - may dew during the healing process.
