| Abstract|| |
Tuberculosis (TB) of the kidney and urinary tract has non-specific symptoms and is easily overlooked. We performed this retrospective study to analyze different findings on excretory urography (IVP) of patients with renal TB. The IVP slides of 25 patients (14 females/11 males, age range 12-63 years) with renal TB diagnosed over a 20-years period were studied for the presence of characteristic findings. They included: renal parenchymal mass, autonephrectomy, hydronephrosis, ureteral stricture and dilatation, and bladder involvement and fibrosis. In our study, the most common findings were ureteral stricture and dilation (13/25, 52%), bladder involvement 13/25 (52%), autonephrectomy 12/25 (48%) and renal parenchymal calcification 10/25 (40%). The most common combined pattern was ureteral stricture-dilation with contralateral autonephrectomy and bladder irregularities. We conclude that kidney TB remains undiagnosed until the advanced stages and awareness about the IVP imaging pattern could help in early diagnosis of this entity.
Keywords: Excretory urography (IVP), Autonephrectomy, Tuberculosis (TB), Hydronephrosis.
|How to cite this article:|
Ardalan MR, Shoja MM. Radiological Findings in Renal Tuberculosis: A Report from Northwest of Iran. Saudi J Kidney Dis Transpl 2008;19:76-9
|How to cite this URL:|
Ardalan MR, Shoja MM. Radiological Findings in Renal Tuberculosis: A Report from Northwest of Iran. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2019 Jul 22];19:76-9. Available from: http://www.sjkdt.org/text.asp?2008/19/1/76/37438
| Introduction|| |
Tuberculosis (TB) is a worldwide health hazard and an infectious disease with multiple clinical patterns. The lungs are the most commonly affected organs followed by lymphadenopathy and genitourinary tuberculosis.  The most common causative organism is Mycobacterium (M) tuberculosis. M. avium may also involve the kidneys in immunosuppressed individuals. Symptoms of urinary TB are non-specific and are typically that of cystitis., Flank pain, back pain and hematuria are seen. However, fever, weight loss and night sweats are usually absent. The definitive diagnosis of urinary TB depends on a positive urine culture, acid fast staining and histological diagnosis.,
Early diagnosis of renal TB is important and can prevent occurrence of renal failure as tuberculosis is still common with rising incidence in certain countries, especially Middle East and Africa.  Intravenous pyelography (IVP) is a feasible procedure that is usually performed on adult patients with chronic complaints related to the urinary tract. Our own experiences indicate that urinary TB is more often than not under-diagnosed by general practitioners and specialists in Iran. Increasing awareness about the IVP imaging findings of kidney and urinary TB may aid clinicians in making an early diagnosis. The goal of this study is to assess the radiological findings of urinary TB.
| Materials and Methods|| |
Between the years 1985-2005, we found 35 patients diagnosed to have urinary TB in the records of the TB and Lung Diseases Research Centre, an institution affiliated to the Tabriz Medical University, Iran. All the patients who had IVP performed at the time of diagnosis were studied. Ten of these patients were excluded for lack of IVP. The IVP findings of the remaining patients were studied. Renal and urinary tract TB was diagnosed by acid-fast stain of urine sample, urine culture or histological study. The patients (n = 25, 14 females and 11 males, aged between 12-63 years) were looked for the presence of findings characteristic of TB on IVP including hydrocalicosis, renal parenchymal mass, autonephrectomy, hydronephrosis, ureteric stricture and dilatation, and bladder involvement and fibrosis [Figure - 1],[Figure - 2]. Hydrocalicosis was defined as a caliceal stricture with dilatation and ballooning of its proximal area. A kidney mass was noted as a mass effect on the renal collecting system; autonephrectomy as failure of excretion of contrast medium into the renal parenchyma. We did not review the chest x-ray findings or renal function tests at the time of diagnosis.
| Results|| |
[Table - 1] summarizes the IVP findings in patients with urinary TB. The most common single finding was ureteral stricture and dilation [Table - 1]A. The most common combined pattern of involvement [Table - 1]B was ureteric stricture and dilatation with contralateral autonephrectomy and bladder involvement [Table - 1] B.
| Discussion|| |
The results of this study showed that patients with urinary TB may have spectrum of findings on IVP that may complicate its diagnosis. Majority of our patients were at advanced stage of renal involvement, which reflects a delayed diagnosis. The kidneys are usually affected by hematogenous cortical seeding following a primary infection mostly in the lungs. However, at the time of presentation of urinary TB, there may be no evidence of active pulmonary disease. ,
An earlier study in Northwest of Iran showed that genitourinary TB was the second most common form of the extra-pulmonary TB after lymphadenitis.  In an other study in this area, the incidence of TB had decreased from 34.5 cases per 100,000 in 1991 to 20 per 100,000 in 1996 and has remained stable since then. However, the reported percentage of non-pulmonary tuberculosis seems to be lower than the expected one. Hence, we believe that the majority of patients with extra-pulmonary TB, particularly of the urinary tract, remain undiagnosed and finally develop end-stage renal diseases. ,
Tuberculosis insidiously destroys the renal parenchyma. The diseases is usually asymptomatic until the purulent material is discharged into the renal pelvis and create TB pyelonephritis. , The infection spreads down the ureters into the bladder and causes mucosal and mural irritations, granuloma formation and finally, scarring. Cystitis, at this time, can easily get overlooked.  The classic "sterile pyuria" may be found. However, occurrence of secondary bacterial infections could be misleading.
Our study reveals that urinary TB remains undiagnosed until the advanced stages. IVP performed for a chronic urinary tract complaint may be a very useful tool in the diagnosis of this entity.
| Acknowledgement|| |
The authors thank Professor S. Rad for excellent comments on Radiographs and Dr K. Ansarine for his advices. The authors are also grateful to Dr. Montazeri and Dr H. Taheri, and M. Habibzadeh from Tuberculosis and Pulmonary Disease Research Centre of Tabriz Medical Science University.
| References|| |
|1.||Eastwood JB, Corbishley CM, Grange JM. Tuberculosis and the kidney. J Am Soc Nephrol 2001;12(6):1307-14. |
|2.||Tanagho EA, McAninch-Jack W. Smith's General Urology; New York: McGraw Hill. 2000:265-70. |
|3.||Shaheen FA, Al-Khader AA. Preventive strategies of renal failure in the Arab world. Kidney Int Suppl 2005;98:S37-40. [PUBMED] |
|4.||Haydarnejad H, Ashrafi H. epidemiologic study of tuberculosis in Tabriz, a 10 years study.Ashrafi H, MD Thesis. 1997; Faculty of medicine, Tabriz University of medical science. Page 17 (thesis is in Persian) |
|5.||Nourizadeh D, Madaen K, Gaderian N. The clinical study of genitourinary tuberculosis in east Azarbaijan province a 15 year period (1988-2002). Medical Journal of Tarbiz University of Medical Sciences 2005;27(3):107-12 (article in Persian). |
|6.||Wang LJ, Wu CF, Wong YC, Chung CK, Chu SH, Chen CJ. Imaging findings of urinary tuberculosis on excretory urography and computerized tomography. J Urol 2003;169(2):524-8. |
Mohammad Reza Ardalan
Nephrology Department, Imam Hospital, Tabriz University of Medical Science, Tabriz University, Tabriz
[Figure - 1], [Figure - 2]
[Table - 1]