Abstract
IntroductionTuberculosis was once a disease much more prominent in the minds of UK urologists. The dramatic reduction in incidence following the success of antituberculous therapy has meant that new generation surgeons have little or no experience of the effects and management of tuberculosis of the kidney. With concern over multidrug resistant tuberculosis, human immunodeficiency virus associated tuberculosis and immigration of persons from areas endemic with this disorder, clinicians may see an increase in cases of renal tuberculosis. Renal tuberculosis “autonephrectomy” is the end stage of chronic renal tuberculosis infection and results from the caseous necrosis and progressive cavitation of the kidney. Resultant calcification may mimic the appearances of a renal calculus on plane film X-ray. Back, flank and abdominal pain are non-specific symptoms often investigated by General Practitioners using plane film X-ray. Clinicians not considering a diagnosis of renal tuberculosis may confuse the radiographic appearances with that of a renal calculus as occurred in our case. Once a diagnosis of tuberculosis autonephrectomy is made the next decision is whether any further investigations and treatment is necessary as the condition has been reported to be a cause of hypertension and reactivation of tuberculosis is also possible.Case presentationWe describe the case of a 66 year old Caucasian female who presented to her General Practitioner with left sided lumber and loin pain. A lumbar spine X-ray showed a calcified mass reported as a renal calculus. Urological opinion was sort and a computerised tomogram confirmed a renal tuberculosis “auto nephrectomy”. The patient had been diagnosed with tuberculosis aged 16. The patient had no lower urinary tract symptoms and normal urinalysis. Although there is some evidence to suggest nephrectomy is beneficial in treating hypertension in these patients (the patient in our case was on two anti hypertensive preparations), the patient did not want to consider surgery as her symptoms had settled spontaneously.ConclusionAlthough very rare in non endemic countries clinicians still need to consider a diagnosis of renal tuberculosis in patients with previous tuberculosis exposure and calcification of the urinary tract. In cases of uncontrolled hypertension consideration should be given to nephrectomy in cases of end stage renal tuberculosis. This decision should be made in consultation with a nephrologist.
Highlights
Tuberculosis was once a disease much more prominent in the minds of UK urologists
Case presentation: We describe the case of a 66 year old Caucasian female who presented to her General Practitioner with left sided lumber and loin pain
In cases of uncontrolled hypertension consideration should be given to nephrectomy in cases of end stage renal tuberculosis
Summary
The estimated tuberculosis (TB) incidence in the UK for 2007 was 15 per 100 000 population with a prevalence of 12 per 100 000 population [1]. A nephrectomy may still be valuable in the following circumstances: (i) if the kidney is calcareous, destroyed and subsequently causing pain or an abscess; (ii) the patient has hypertension alongside a unilateral renal lesion; (iii) recurrent UTI’s causing persistent symptoms; (iv) suspicion of malignancy in one of the kidneys which has been damaged by renal TB. They are the cause of (i) abscess formation with cutaneous sinus tracts and (ii) systemic hypertension which are the complications that may occur in the end stage non- functioning kidney. It is unlikely that chemotherapy alone prevents these complications from occurring as both are associated with sterile organs [5]
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