RT Book, Section
A1 Dirkx, Tonja C.
A1 Woodell, Tyler B.
A2 Papadakis, Maxine A.
A2 McPhee, Stephen J.
A2 Rabow, Michael W.
A2 McQuaid, Kenneth R.
SR Print(0)
ID 1184183515
T1 Renal Manifestations of Tuberculosis
T2 Current Medical Diagnosis & Treatment 2022
YR 2022
FD 2022
PB McGraw-Hill Education
PP New York, NY
SN 9781264269389
LK accessmedicine.mhmedical.com/content.aspx?aid=1184183515
RD 2024/04/24
AB Renal  tuberculosis  usually  results  from  hematogenous  spread  and  is  an  underdiagnosed  entity.  Up  to  20%  of  patients  with  extrapulmonary  tuberculosis  have  urogenital  involvement,  of  which  the  kidney  is  most  commonly  affected.  Its  classic  manifestation  is  the  presence  of  microscopic  pyuria  without  bacterial  growth  on  urine  culture—or  “sterile  pyuria.”  More  often,  other  bacteria  are  also  present,  and  microscopic  hematuria  may  coexist.  Urine  cultures  were  once  the  gold  standard  for  diagnosis,  but  the  advent  of  urine  nucleic  acid  testing  for  tuberculosis  has  increased  sensitivity.  Characteristic  findings  on  imaging  include  papillary  necrosis  and  cavitation  of  the  renal  parenchyma.  Ureteral  strictures  or  calcifications  may  also  be  present.  Kidney  biopsy  is  not  usually  needed  to  confirm  the  diagnosis  but  reveals  granulomatous  inflammation  and  tubulointerstitial  nephritis.  Prompt  initiation  of  antituberculosis  treatment  is  indicated,  without  which  progression  to  ESKD  occurs  due  to  chronic  inflammation  and  obstruction.