Kidney and Tuberculosis

Abstract

Genitourinary tuberculosis is the second most common form of extrapulmonary tuberculosis after lymph node involvement. It can involve any part of the genitourinary system and presentation may vary from vague urinary symptoms to chronic kidney disease. The kidney is usually the primary organ infected in the genitourinary system and renal involvement of tuberculosis often does not present with classic symptoms of fever, weight loss, or night sweats. Tuberculosis of the urinary tract is, therefore, easily overlooked. In patients with a diagnosis of genitourinary tuberculosis, only 10% show signs of active pulmonary tuberculosis and the latency period between the initial tuberculosis infection and diagnosis with renal disease may be as long as 5–40 years. Direct infection of the kidney and lower urinary tract, and secondary amyloidosis are major forms of well-documented renal involvement. However, in recent years, an increasing number of data have reported that, independent of drug therapy, tuberculosis itself can cause glomerular and tubulointerstitial lesions, and patients may present with either acute or chronic renal failure with proteinuria. The most frequent renal biopsy finding in patients with renal involvement is chronic tubulointerstitial nephritis. Progression to end-stage renal failure may be higher than currently believed because there is little evidence as to the extent to which tuberculosis is a cause of end-stage renal failure worldwide. Tuberculosis should be considered as a possible origin of both acute and chronic renal failure, especially in countries where the incidence of tuberculosis is high. Timely diagnosis and treatment may prevent acute forms of renal disease and late sequelae of pulmonary tuberculosis. Kidney biopsy should be considered in the clinical evaluation of kidney dysfunction with tuberculosis and also in cases with unusual presentations.