Renal Tuberculosis

Renal TB holds an important place in genitourinary TB; other genitourinary organs are mostly secondary to it. Thus genitourinary TB should be viewed both as part of systemic TB and as a system-wide process. Bacilli first form foci in the glomerular capillary plexuses without symptoms; most foci resolve as host resistance strengthens (pathological renal TB). Heavy, virulent infection with low resistance reaches the renal medulla and papillae, producing symptoms (clinical renal TB).

Common Symptoms

Back pain; station doctor; frequency; bladder irritation signs; pyuria; hematuria; night sweats; low fever; bladder TB; dysuria; urgency

Causes and Pathogenesis

Humans are easily infected, but the response depends on bacillary number/virulence and host immunity. The first infection is primary; later infection is post-primary. At 3-4 weeks after infection, cell-mediated immunity and delayed hypersensitivity replace early nonspecific inflammation with granulomatous tubercles (lymphocytes, macrophages, central caseation); 90% control the infection. Renal TB is almost always secondary to pulmonary TB, occasionally osteoarticular, lymphatic, or intestinal. Bacilli reach the kidney via hematogenous, urinary, lymphatic, or direct spread; hematogenous spread is the main route and often bilateral, though clinically unilateral (~85%) because contralateral mild lesions self-heal; bilateral clinical renal TB is ~10%. Pathology shows >80% bilateral involvement.

Treatment

Drug therapy, symptomatic treatment, supportive therapy

Preventive Measures

The US CDC (1989) proposed a 20-year strategy to eliminate TB: 1. Prevent progression from infection to disease with isoniazid 300 mg/day or intermittent (3×/week) for 10-30 doses in close contacts and high-risk groups. 2. Use new technology for species/genus-specific antigens, monoclonal antibodies, and DNA probes for early diagnosis. 3. Develop vaccines more effective than BCG. 4. Develop more effective anti-TB drugs; controlling TB will correspondingly reduce renal TB.

Department to Visit

It is recommended to visit the Nephrology department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.