Renal tuberculosis occurs when an organ is infected with mycobacteria. The causative agent belongs to the group of anaerobic, is transmitted with blood, spreads through the body with the flow of lymph. When infected with mycobacteria, a person does not always develop renal tuberculosis. The disease is observed if several significant factors simultaneously influence.
Basic information
For kidney tuberculosis to appear (except for infection with pathological microflora), it is necessary to weaken the parenchyma of the organ, usually due to a deterioration in the quality of blood flow. There is a higher probability that the infection will end with a disease if a person has reduced immunity, kidney tissues are the area of localization of inflammatory foci. If the disease occurs, it leads to a deterioration in the functionality of the organ. Some forms of mycobacteria are characterized by increased resistance to antimicrobial drugs. This variant of the disease is more likely to lead to a lack of functioning of the organ.
As doctors say, kidney tuberculosis in half of the cases (and sometimes even a little more often) takesdestructive form. Symptoms appear on average six years after the initial infection. Timely diagnosis and clarification of the case before this period is extremely difficult.
How to notice?
The first signs of kidney tuberculosis are divided into local, general. A person often feels tired, often the temperature rises relative to the norm. Worried about high blood pressure. Studies show gross hematuria, an increased erythrocyte sedimentation rate. When studying the renal parenchyma, it is possible to detect foci of destructive processes, pus discharge.
Local symptoms of kidney tuberculosis in adults (and children) include back pain. Analyzes show pyelonephritis, the study of the kidney parenchyma gives an idea of the destructive processes.
Development of disease
The first signs of kidney tuberculosis usually appear only 5-7 years after infection with mycobacterium. The duration of the incubation period is one of the main obstacles to the timely diagnosis of the condition. Certain difficulties are associated with the reduced sensitivity of the pathogen to antibiotics. If during the incubation period the patient uses antimicrobial drugs to eliminate other inflammatory processes, then this increases the resistance of mycobacteria, that is, it creates difficulties in the future for the treatment of the disease. About 70% of cases do not show any symptoms during the incubation period.
About a third of patients already in the first years experience some symptoms,the first signs of tuberculosis of the kidneys. The temperature rises to subfebrile, but not higher than 38 degrees, the patient often feels tired, weak. From time to time, pain is localized in the lower back.
One of the characteristic signs is urine in case of kidney tuberculosis, containing inclusions of pus. Laboratory studies can show the presence of a pathogen in the secretions, sometimes there are protein fractions, erythrocytes, leukocytes. There are no specific phenomena in renal tuberculosis. Urine is acidic, when sowing, infection can be established in a two-week period, but it is extremely rare that such an analysis is prescribed to a person during the incubation period - there is simply no reason for this.
Disease progression
Usually indicate the need to treat the symptoms of kidney tuberculosis at an advanced stage. The process is accompanied by complications, it is for their reason that the patient usually seeks medical help. Tuberculosis can provoke inflammation of the prostate, urethra, appendages. Dysuric disorders are possible, back pain becomes very severe, blood fractions are observed in urine. Such symptoms indicate the development of the disease.
Acute symptoms are extremely rare. With pathology, an increase in pressure is possible, a general state of poisoning. When kidney tuberculosis spreads to the upper regions of the ureter, the bladder, dysuric failures are possible. Another sign is paranephritis.
Additional symptoms
In renal tuberculosis, pyelonephritis, pyonephrosis, paranephritis are possible. Atsome patients reveal cavities, papillitis. In the terminal stage, the disease leads to kidney failure.
Tuberculosis progress is slow but steady. The symptoms are gradually getting stronger. The spread of the pathogen in the kidneys is usually observed against the background of damage to the respiratory system. If mycobacterium is detected in the lungs, there is a high probability that kidney damage will be detected in 5-7 years.
Spread of pathology
More often, the symptoms of kidney tuberculosis occur when the pathogen enters the human body with blood. Pathological organisms are localized in the parenchyma. If the foci are small, and the immunity is strong, then self-scarring of the area is possible without specific treatment. There are no symptoms in this case. With a decrease in the immune status, the infection gets the opportunity to hit the kidney crust, the medulla of the organ. At this stage, tuberculous papillitis appears. Gradually, mycobacteria infects the pyramids of the kidneys.
Without specific symptoms, tuberculosis of the kidneys gradually spreads to internal structures, disrupts the functioning of the cups and pelvis of the organ, and leads to the appearance of caverns. Foci become places of calcium accumulation, it can be detected by X-ray examination of the organ.
Gradually, the process from the kidneys extends to the bladder and the path of the urine duct. The patient has chronic pyelonephritis, possibly the appearance of kidney stones. There are frequent cases when diseases are considered independent, a course is prescribed for their treatment, but it is not possible to determine that the root cause is tuberculosis.
Step by step: forms of disease
The first stage is parenchymal. It is followed by papillitis, after which - the formation of caverns. The next stage in the development of the disease is pyonephrosis, after which post-changes are observed.
The initial stage is the lesion of the renal parenchyma without destructive foci. The disease can be manifested by an increase in the concentration of leukocytes in urine. It is impossible to find the causative agent in the secretions, since the bacteria cannot pass the glomerular filtration process. It is possible to establish the disease at this stage through PCR and certain types of microscopy. The prognosis is best if the pathology can be identified in time.
Papillitis is the second stage in the development of tuberculosis. Mycobacterium can be found in urine. The most accurate method for diagnosing tuberculosis of the kidneys is culture. Therapy is conservative. A possible complication is a decrease in the lumen of the ducts for urine.
The cavernous step of development can be detected by ultrasound examination of the organ. A single cavity appears. When the lesion is bilateral, the prognosis is negative. A biopsy should be done to clarify the case.
Terminal stage - the presence of several caverns. Secondary infection is accompanied by purulent fusion. Complications are high.
How to clarify?
Renal tuberculosis test - Mantoux test. If a disease is suspected, an ultrasound examination is prescribed to assess the condition of the ureter and tissues nearby.
To detect mycobacteriaurine samples are taken from the patient's secretions for culture. Pretty accurate information about a person's condition can be obtained through PCR. The blood of a person who is suspected to have TB is injected into a guinea pig to assess the progress of the situation. Refinement of the case is possible by means of fluorescence microscopy.
Renal tuberculosis in children, adults can manifest itself as purulent fractions in the urine, which is a secondary symptom that simplifies the diagnosis. Also indirect manifestations include gross hematuria, coverage of the cavity with a calcium layer, the appearance of specific tubercles on the mucous membranes of the urinary system.
How to fight?
Conservative treatment of kidney tuberculosis is possible with the first and second degree. The patient is prescribed for each day 0.3 g of Isoniazid or 0.3 g of Rifampicin or 0.4 g of Ethambutol. The drugs are used three times daily. In the third and fourth stages, the patient can only be helped by surgical intervention.
For the treatment of tuberculosis of the kidneys, Isoniazid is sometimes used at a frequency of once every seven days, twice a week or every other day. "Rifampicin", "Protionamide" are often prescribed daily or every two days. If "Pyrazinamide", "Ethambutol" are prescribed, they are usually used 1-2 times a week or every other day.
Varies from once a week to use every other day, the frequency of taking Streptomycin sulfate, Capreomycin. Cycloserine is used every two days. If the doctor recommends stopping on fluoroquinolones, such drugs are used daily or once every two days. A day later orTake "Kanamycin sulfate" 1-2 times in seven days.
Features of treatment
You should not try to cure tuberculosis with medications at your own discretion without consulting a doctor. Only a doctor can prescribe the optimal program, choose the dosage. When choosing the rules for taking and specific items, the doctor evaluates underlying diseases, the presence of complications, patient tolerance to drugs, and the quality of kidney function.
If the medical course is ineffective, the disease has progressed significantly, surgical intervention is necessary. To prevent the spread of infection, the diseased kidney is removed. The installation of an artificial ureter avoids serious problems with urine drainage.
The duration of treatment for renal tuberculosis often reaches two years. After the diagnosis is made, the patient is placed in the first accounting group for inpatient treatment. In the absence of mycobacteria activity for two years, the group is changed to 3B. In the chronic course of the disease, the second accounting group is assigned.
Consequences and warning
Tuberculosis can cause kidney failure and the development of a fistula in the lumbar region. The cavern can break through. There is a possibility of increased pressure in the aorta. Tuberculosis can provoke paranephritis.
The main method of preventing renal tuberculosis is to increase the immune status and minimize the risk of contact with a carrier of a pathological microorganism. In practice, excludesuch interaction is practically impossible: medical studies have shown that only in public transport a person daily encounters at least two carriers of the infection. Fortitude cannot provide even strong immunity, but at present there is simply no other method of minimizing risks.
To reduce the danger, you need to avoid bad habits, give yourself a quality night's rest, eat well. Any diseases, infectious and inflammatory processes must be treated in a timely manner.
Relevance of the issue
Among all forms of tuberculosis localized outside the lungs, it is the renal variant that occurs most often. As a rule, the disease is secondary, appears against the background of damage to the respiratory or musculoskeletal system. Tuberculosis is one of the most common diseases. It is no secret that it is possible to become infected with various forms by aerosol and even by touching an object used by the patient. Blood flow, lymph flow allow pathological microflora to penetrate into the kidneys. In this organ, the blood moves through the vessels rather slowly, as the fluid is filtered. In addition, there are many vessels themselves. All this forms a convenient environment for the reproduction of mycobacteria, the likelihood of developing an infectious focus is significantly higher than in other organs.
Tuberculosis develops in representatives of different age groups, with different genders. Up to 2% of patients are children under ten years of age, one patient out of ten is a patient under twenty years of age. knownisolated cases of renal tuberculosis in infants. In childhood, most often, due to infection with pathological microflora, the kidneys and respiratory system or bones and kidneys suffer.
Pay attention
Koch's sticks in the primary stages of the disease can only be detected quite by accident, if the patient gives urine for research for a different reason. Often, infected foci heal on their own, but it is possible for pathological microflora to settle, which remains passive for a long time. The resumption of progress begins when a favorable situation develops, several factors affect the human condition. In addition to a decrease in immunity, general hypothermia or exhaustion, an infectious disease, can provoke the growth of a colony. Tuberculosis can activate a disease localized in the urine ducts if this leads to a violation of the excretion of fluid.
Most often, an accurate diagnosis of tuberculosis can only be made in a specialized institution. You should contact the dispensary if purulent fractions are observed in urine for some time. Especially attentive should be persons who often suffer from cystitis, pyelitis, pyelonephritis.
Nuances of the disease
If tuberculosis is suspected, urine must be taken for examination. The most accurate results will be when taking fluid according to the method developed for this. For women, a catheter is placed in the bladder to obtain samples of secretions. For men, the following technology has been developed: first, two vessels are filled with an equal amount of urine in the process of one continuousurination, then the liquid from the first container is checked for leukocyte concentration, the second - for the presence of markers of inflammatory processes in the prostate gland. When purulent fractions are detected, we can confidently speak of a pathological process localized in the kidneys and urinary system.
If the kidneys are working normally, there are no symptoms indicating a lack of functioning, there are no protein inclusions and cylindruria, the patient is shown urography. You can determine tuberculosis by angiography, radioisotope analysis, ultrasound examination of internal organs.
