Therapeutic options of tuberculous nonfunctioning kidneys

Park, Won Hee; Lee, Chong Koo; Lee, Chongwook

Abstract

We analyzed 57 patients with tuberculous nonfunctioning kidneys, which were diagnosed pathologically or bacteriologically at Seoul National University, from October 1981 to December 1989. The patients were divided into 3 groups according to the treatment ; Group 1 : 12 patients, only chemotherapy for more than 12 months ; Group 2 :32, nephrectomy and chemotherapy for more than 6 months ; Group 3 . 13, nephrectomy and chemotherapy only for 3 months. As a standard antituberculous regimen, isoniazid, rifampin, and ethambutol were used, and pyrazinamide was added in 15 patients. The follow-up tests were urinalysis, urine AFB smear and culture, and intravenous pyelography. The duration of the follow-up was 6 to 1O8 months, with a mean of 23.3 months. There was no evidence of recurrence in any patient among the 3 groups. Two postoperative complications (hematoma and fistula formation) occurred in 45 nephrectomized patients. Pathologic examination of the resected kidneys revealed findings compatible with tuberculosis in all patients of Groups 2 and 3. Coexisting cortical adenomas were found incidentally in 2 patients. Final diagnoses of the other 2 patients were hydronephrosis and chronic pyelonephritis without any evidence of tuberculosis, although these 2 patients were excluded in this study. Severe drug toxicity occurred in 7 patients that belonged to Groups 1 and 2. In conclusion, early nephrectomy for accurate diagnosis and removal of infective foci was the justifiable initial procedure, and this should be followed by postoperative antituberculous chemotherapy for the shortest acceptable period in tuberculous nonfunctioning kidneys. In highly selective cases where the lesion is completely localized in one kidney, we can consider early nephrectomy and a 3-month course of chemotherapy as one treatment modality.