Clinical Observation of Renal Tuberculosis

Kim, Chung Chan; Cho, Jae Eeung

Abstract

Clinical observation of renal tuberculosis was made on 44 cases who were admitted to the Department of Urology. Seoul Adventist Hospital, during the period from January 1973 to December 1978. The results are summarized as follows: 1. During this period, the total number of in-patients was 782 among which 44 cases had renal tuberculosis. giving a rate of 5.6% of total in-patients. The ratio of the annual number of renal tuberculosis cases against total number of urologic in-patients is decreasing significantly. 2. 24 cases (54.5%= out of 44, were in the age group of 21 to 40, and male to female ratio was 1.6: 1. 3. Both kidneys were affected in 21 cases (47.8%), while l3 cases (29.5%) involved the left kidney and 10 cases (22.7%) the right one. 4. The frequent subjective complaints were as Follows: Frequency in 70.5%, gross total hematuria in 68.2%, painful urination in 56.8% and flank pain or dullness in 52.3%. 5. 43.2% of the cases visited the hospital within 6 months after onset of the symptoms. 6. 68.2% of the cases were associated with active or healed pulmonary tuberculosis. 7. Other presenting tuberculous lesions and combined diseases were as follows: Tuberculous epididymitis in 5 cases, tuberculous lymphadenitis in 3 cases, contracted bladder in 11 cases. Uremia in 4 cases and urinary stone in 3 cases. 8. Normal ranges of BUN and Creatinine were found in 34 cases and 37 cases respectively and in creased ESR was found in 28 cases. 9. Urinalysis findings revealed proteinuria in 72.7%, hematuria in 93.2% and pyuria in 84.1%. Urine AFB was found in 61.4% by Ziehl Neelsen`s method and in the 38.6% of negative stains, urine AFE culture revealed positive in 6.8%. 10. On the excretory urogram of 65 kidneys, functional changes are as follows. Nonvieualization in 41.6%, caliectasis in 3O.8%, hydrourettronephrosis in 23.6%. moth-eaten appear ance in 18.5% and contracted bladder in 25.0%. 11. Retrograde or antegrade pyelographic changes of the l9 non-visualized kidneys on excretory uro-gram are as follows: hydronephrosis in 52.6%, caliectasis in 36.8%, parenchymal destruction in 3l.6 % and cavity with pyonephrosis in 21.1%. l2. The patients were managed by chemotherapy only in 11 cases and combined chemotherapy and nephrectomy in 28 cases, nephrostomy in 13 cases and ileocystoplasty in 4 cases. 13. Histopathologic findings of 28 nephrectomized kidneys disclosed parenchymal tuberculous granulomas in all cases and severely atrophic changes in 1 cases.