Home About us Current issue Back issues Submission Instructions Advertise Contact Login   

Search Article 
  
Advanced search 
 
Saudi Journal of Kidney Diseases and Transplantation
Users online: 149 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
 

Table of Contents   
CASE REPORT  
Year : 2016  |  Volume : 27  |  Issue : 1  |  Page : 161-163
Unusual presentation of tuberculosis in the form of a bilateral renal pseudotumor


Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, U. P., India

Click here for correspondence address and email

Date of Web Publication15-Jan-2016
 

   Abstract 

Genitourinary tuberculosis (TB) is a common form of extrapulmonary tuberculosis. The kidneys are usually affected by hematogenous seeding at the time of primary pulmonary infection. Genitourinary TB has non-specific clinical presentations and variable radiographic appearances. We are reporting a case of genitourinary TB presenting as bilateral renal mass. The patient underwent computed tomography-guided kidney biopsy that showed a granulomatous lesion. Then, the patient was put on anti-tuberculous treatment with a good response. We feel that patients having multiple bilateral kidney lesions should undergo biopsy to determine the nature of the lesion before any surgical intervention.

How to cite this article:
Singh SK, Singh A, Kumar A. Unusual presentation of tuberculosis in the form of a bilateral renal pseudotumor. Saudi J Kidney Dis Transpl 2016;27:161-3

How to cite this URL:
Singh SK, Singh A, Kumar A. Unusual presentation of tuberculosis in the form of a bilateral renal pseudotumor. Saudi J Kidney Dis Transpl [serial online] 2016 [cited 2019 Nov 21];27:161-3. Available from: http://www.sjkdt.org/text.asp?2016/27/1/161/174201

   Introduction Top


Genitourinary tuberculosis (TB) is a common form of extrapulmonary disease; an estimated 4-20% of individuals with pulmonary infection develop genitourinary involvement, mostly in developing countries. [1] Genitourinary TB is more common in men than in women. The kidneys are usually affected by hematogenous cortical seeding at the time of primary pulmonary infection. However, at the time of presentation, there may be no active pulmonary disease. [1],[2] Infection can also occur in the setting of late reactivation disease or miliary disease.


   Case Report Top


A 46-year-old female having no comorbidity presented with a history of flatulence and constipation for four months and generalized weakness for three months. On evaluation, she was having anemia and on ultrasound abdomen, right kidney45 mm × 35 mm hyperdense mildly enhancing lesion in the upper and mid poles and left kidney41 mm × 11 mm upper pole mass with few paraaortic and aortocaval lymph nodes. On the contrast-enhanced computed tomography (CT) scan, there was a 45 mm × 35 mm hyperdense mildly enhancing lesion in the mid-part of the right kidney and 41 mm × 11 mm upper polar lesion at the left kidney and a few para-aortic and aorto-caval lymph nodes [Figure 1]a, b and [Figure 2]a. Routine urine microscopy showed ten to 12 pus cells/HPF, urine culture was sterile and upper and lower gastrointestinal endoscopies were normal.
Figure 1:

Click here to view
Figure 2:

Click here to view


Three samples of urine for acid fast bacilli were negative. On hematological evaluation, the cause for anemia was iron deficiency. Ultrasound-guided fine needle aspiration cytology was performed, which showed an inflammatory pathology. It was then confirmed by CT-guided Trucut biopsy of the renal masses, which showed granulomastous inflammation [Figure 2]b and [Figure 3]. Chest X-ray was normal. She was put on iron replacements for anemia and conservative medical treatment in the form of anti-tubercular drugs for the renal masses. During follow-up, there was a decrease in the size of the renal masses. The patient symptomatically improved and is doing well.
Figure 3: Granuloma, necrosis along with gaint cells under 40× on H&E stain.

Click here to view



   Discussion Top


Genitourinary TB has non-specific clinical presentations and variable radiographic appearances that often mimic many other pathologic lesions. [3] The excretory urogram may be normal in the earlier stages. In the later stage, calcifications occur in approximately one-third of the cases. In rare cases, urinary tuberculosis manifests as either single or multiple parenchymal nodules without urinary tract involvement known as the pseudotumoral type, as in our case. Pseudotumors present with variable sized, but well-defined parenchymal nodules on cross-sectional images. [3],[4],[5] Clinical and radiological findings mimic those of a renal cancer and may simulate a renal hydatid cyst or a pseudotumoral xanthogranulomatous pyelonephritis. [3],[6]

A surgical removal of the mass may happen for this medically treatable case as diagnosis is often suspected only intraoperatively and confirmed only on histopathology later. Surgery must be followed by anti-tuberculous therapy for at least eight months. [3],[7]

From our experience of this case, we recommend that patients having multiple bilateral kidney lesions should undergo biopsy to determine the nature of the lesion before any surgical intervention.

Conflict of Interest: None declared.

 
   References Top

1.
Eastwood JB, Corbishley CM, Grange JM. Tuberculosis and the kidney. J Am Soc Nephrol 2001;12(6):1307-14.  Back to cited text no. 1
    
2.
Tanagho EA, McAninch-Jack W. Smith's General Urology; New York: Mcgraw-Hill. 2000:265-70.  Back to cited text no. 2
    
3.
Njeh M, Jemni M, Abid R, Karray MS, el Ouakdi M, Ayed M. Renal tuberculosis with pseudotumoral form: apropos of a case. J Urol (Paris) 1993;99:150-2.  Back to cited text no. 3
    
4.
DAS KM, Indudhara R and Vaidyanathan. Sonographic features of genitor urinary tuberculosis; Am J Roentgenol 1992;158:327-9.  Back to cited text no. 4
    
5.
Le Guillon M., Ferriere JM., Pourquie J., Gaston R., Zaranis C. Ann Urol (Paris) 1982;16:24951.  Back to cited text no. 5
    
6.
Merran S. Diagnostic case: pseudotumoral tuberculous pyelonephritis. J Radiol 1995;76: 11224.  Back to cited text no. 6
    
7.
Sarf I, Dahami Z, Dakir M, Aboutaeib R, el Moussaoui A, Joual A, El Mrini M, Meziane F, Benjelloun S. A new case of pseudotumoral renal tuberculosis. Ann Urol 2001;35:34-6.  Back to cited text no. 7
    

Top
Correspondence Address:
Sanjeet Kumar Singh
Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow - 226 014, U. P.
India
Login to access the Email id


DOI: 10.4103/1319-2442.174201

PMID: 26787587

Rights and Permissions


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
   
 
 
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    Abstract
   Introduction
   Case Report
   Discussion
    References
    Article Figures
 

 Article Access Statistics
    Viewed1453    
    Printed10    
    Emailed0    
    PDF Downloaded273    
    Comments [Add]    

Recommend this journal