RENAL TUBERCULOSIS IN CHILDREN

Abstract

Genitourinary tuberculosis in children is not easily detected because symptoms are usually minimal, the erythrocyte sedimentation rate is not elevated and the number of leukocytes in the urine may be very few even when the renal destruction is far advanced. The disease is serious because it tends to invade and destroy both kidneys if untreated. Nephrectomy alone failed to arrest the disease in two of six children with cavitary tuberculosis. Chemotherapy with three drugs arrested the disease in all of the five patients with cavitary lesions treated to date. The follow-up of the cases treated by chemotherapy is shorter than that of the nephrectomy cases. Ten patients with noncavitary kidney tuberculosis have all had negative urine cultures since multiple-drug chemotherapy. Tuberculosis showed a tendency to lie dormant in the kidneys for long periods (up to 12 years) and then become active again. Although this series is small and the follow-up is short, the results to date parallel those found in our larger experience with chemotherapy in adults with genitourinary tuberculosis. In general, as in adults, modern triple-drug chemotherapy appears to be about as effective, if not more effective, then nephrectomy, as treatment for this potentially bilateral disease. As a consequence, at the authors' clinic, nephrectomies are currently being deferred indefinitely, due to the apparent success of chemotherapy. Whether chemotherapy will entirely replace excisional therapy for genitourinary tuberculosis is still problematical, but it has certainly greatly enhanced the outlook for patients with this once lethal disease.