Pyelographic Observation on Renal Tuberculosis

Kim, Tai Chin; Lee, Hak Song

Abstract

Pyelographic examination is very essential in diagnosis of renal tuberculosis along with detection of tubercle bacilli in the urine and cystoscopic procedure. Furthermore, it is that the pyelography gives the very important and influencing information on therapeutic indication, surgical intervention how to and when to operate, and on forecasting prognosis. It therefore, is requested that grade of tuberculous invasion, its correct localization and its itemized classification be established most carefully. In the present study, 120 pyelograms made out of 197 cases of renal tuberculosis at the Department of Urology. Seoul National University Hospital, during the period January 1957 through June 1963, were collected and detailed pyelographic interpretation on plain films, intravenous pyelograms (I.V.P.) of individual tuberculous kidneys (from 120 patients) and on 50 retrograde pyelograms was attempted and the following results were obtained: Thereafter, an individual kidney will be counted as one case. 1) Of 152 cases of plain film, calcification in the kidney area was found in 6 cases or 3.9%, and renal calculus in 4 cases or 2.6%, kidney outline was observed in 24.3%. Plain film should be all made prior to perform pyelography. 2) Functional classification of intravenous pyelogram was made into 5 groups according to grade of visualization of contrast media as the following Group 1: Pelvio-calyceal system is well visualized, revealing the neighborhood of uretero-pelvic juncture precisely. Group 2: Most calyces are essentially visualized but no pelvis is outlined. The entire picture can not be drawn. Group 3: Only one to two calyces or cavities are filled with contrast media. They appear at most times round, oval or hazy figures. This group may stand for advanced group 2. Group 4: Contrast media seem to be visualized in traces but no outline of calyx nor pelvis observable. Group 5: Absence of visualization. 3) Most commonly observable urographic changes in intravenous pyelogram can be listed as: (1) absence of visualization, 43.1% ;(2) delayed visualization, 37%; (3) caliectasis, 36% ; (4) feathery, irregular or "moth-eaten" outline of calyces, 33.5%; (5) deformity, narrowing or dilation of the ureter, 26%; (6) obliteration of one or more calyces, 8.6% ; (7) cicatrical deformity of the calyces and "pinching off" of the tips of minor calyces, 7.2% ; (8) poor visualization with only one or two "globs" of contrast medium, 5.9% and (9) pyelectasis, 2.6%. 4) After injecting contrast media in intraveuous pyelography, the more the kidney involved, the lower the appearance and the intensity of nephrogram observed. 5) Retrograde pyelograms were classified into four grades after Lattimer and they were studied along with appearance of contrast media in intravenous pyelogram. The more invasion by retrograde pyelogram indicated, the later the appearance of contrast media and the poorer visualization observed. 6) Retrograde anatomical grading and intravenous functional classification were compared and it was almost likely that they paralleled pretty well. Nintythree per cent of I.V.P. below group 2. inclusive, showed more marked anatomical involvement than grade III of retrograde pyelogram.