Renal Tuberculosis Research Articles

Is neoadjuvant chemotherapy necessary for the surgical treatment of renal tuberculosis?

The relevance of urogenital tuberculosis remains high as well as its social significance. With the advent of anti-tuberculosis drugs it became possible to perform organ-preserving surgeries, both anti-tuberculosis chemotherapy in the preoperative period and after surgery is extremely important. Violation of this principle leads to the development of severe complications, which is demonstrated by clinical observation. Patient I., female 40 years. Diagnosis: polycavernous tuberculosis of the right kidney, cavernous tuberculosis of the left kidney, bladder tuberculosis of stage 4 (microcystis). Her anti-tuberculosis therapy was irregular and occasionally. In the general urology department a laparoscopic nephrectomy on the right and nephrostomy on the left were performed. Anti-tuberculosis therapy was discontinued, which led to the progression of renal failure and repeated attacks of pyelonephritis. In this regards she was re-operated in the Avicenna Medical Center: laparoscopic cavernotomy of the left solitary kidney and cystectomy with enterocystoplasty by Studer were performed. In the postoperative period a reservoir-uterine fistula was formed. She did not receive anti-tuberculosis therapy. The patient returned to the Avicenna Medical Center after 9 months, laparoscopic removal of the shrunken intestinal reservoir was performed with the formation of Bricker ileal conduit with a good short-term and long-term (follow-up period of 10 months) result.

Presentación de reporte de caso: Estallido renal espontaneo por tuberculosis

Abstract Introduction Tuberculosis is responsible for the majority of deaths associated with infectious disease. The main involvement in the lung followed by extrapulmonary genitorurinary location, with a predominance of the kidney, epididymis and prostate respectively. The symptoms are nonspecific, suspected in patients with chronic pathologies or a previous diagnosis of pulmonary tuberculosis. The Gold Standard is the identification of the Bacillus in urine or infrequent techniques such as tuberculin injection. In diagnosed patients, treatment is based on 4 drugs (isoniazid, rifampicin, ethambutol and pyrazinamide) up to combined therapies, the duration of treatment is according to the symptoms and characteristics of the patient. Objective. We present the case of a young patient with spontaneous renal flare associated with tuberculosis with medical treatment and emergency surgery and multisystemic deterioration associated with hemodynamic shock. Conclusion. Genitourinary tuberculosis is characterized by a nonspecific clinical picture making timely diagnosis difficult, the symptoms are related to the compromised organ, suspecting in patients with chronic, nutritional and immunodeficiency alterations, being of vital importance a rapid diagnosis and effective treatment evaluating each patient individually. In this report, a patient with multiple antecedents presents a complication of renal tuberculosis not described in the literature, with immediate surgical intervention and deterioration in her clinical evolution.

Хирургическое лечение обструкции верхних мочевых путей при туберкулезе мочевой системы

Introduction. Currently, the basis for effective treatment of urinary tuberculosis (UT) is a combination of specific chemotherapy with reasonable surgical intervention and strict follow-up of the patient. Materials and methods. This literature review presents the evolution of methods of surgical treatment of renal and upper urinary tract tuberculosis over of 127 sources found for the review, 63 were selected. Results. Since UT is a very slowly progressive disease with minimal and imperceptible symptoms, often leading to irreversible organ damage, up to 75% of patients with this pathology undergo surgery. As follows from the results of recent studies, the emphasis of surgical treatment is increasingly shifting from ablative and organ-carrying techniques to reconstructive operations. Surgery for upper urinary tract tuberculosis continues to develop, but its results in advanced cases of destruction of renal tissue often remain unsatisfactory. Conclusions. The search for new methods of reconstructive interventions, the purpose of which is to preserve functioning renal-ureteral units and improve the quality of life of patients, remains relevant.

Amerigo Filia (1873-1925) and the first School of Pediatrics in the island of Sardinia

Amerigo Filia was born on July 18, 1873, in Sassari, Sardinia, Italy. After attaining his Medicine degree at the University of Turin in 1900, he went to Rome to study Pediatrics at the School of Pediatrics directed by Professor Luigi Concetti. His academic career began in Sassari when he was appointed as teacher of Pediatrics in 1911, becoming Full Professor in 1917, Dean of the School of Medicine and Surgery in 1918 and, finally, Rector of the University in 1919. He distinguished himself as the founder of the Pediatric Clinic and the School of Pediatrics in Sassari, both being the first ones in Sardinia, and as the promoter of the restoration of the front of the main building of the University of Sassari (“Palazzo dell’Universita”), as well as of new buildings to host Scientific Institutes and Clinics. Moreover, in 1923, he succeeded in preventing the suppression of Sassari University as a consequence of the “Gentile” reform. As documented by his scientific publications, Filia’s research activity included both experimental and clinical studies focusing on the renal excretion of high dose of arsenic, the effects of Lactobacilli in infantile enteritis, as well as on renal tuberculosis and pulmonary echinococcosis in children. Amerigo Filia died suddenly on December 21, 1925, in Rome, where he was participating in a university competition as a committee member.

Spectrum of Renal Lesions on Autopsy: Experience of a Tertiary Level Institute Based on Retrospective Histopathological Analysis.

Introduction: Last few decades have seen a remarkable increase in the elderly population. Aging is an established risk factor for chronic kidney diseases associated with increased mortality and morbidity. The frequency and spectrum of renal pathology on autopsy specimen is not well documented and is often overlooked by physicians as well as forensic pathologists.Aim: The present study aims to find out the prevalence and pattern of various types of renal pathologies, based on the histopathological analysis of renal tissue where autopsies were performed whether related or unrelated to renal diseases.Material and methods: This retrospective study of six years consisted of 557 autopsies. The bits of 417 samples of kidney tissue/whole kidney, retrieved at the time of autopsy were received, processed, and examined.Results: The male to female ratio approximately was 2:1, and 83.69% of cases were in 11-50 years age groups. Among the 159 cases having definitive renal findings, the commonest pathologies were seen in tubules and interstitial tissues (58.49% cases), followed by 38.36% cases with involvement of all components of renal tissues. There were four cases of isolated vascular changes and one case having Hodgkin’s lymphoma. The series had 12 cases of renal tuberculosis.Conclusions: The study highlights the various lesions of kidney found in renal tissue obtained on autopsy. The physician as well as forensic pathologists must be aware of the high prevalence and wide spectrum of possible pathologies in the kidney. The focus should be to develop more efficacious diagnostic methods for timely intervention.

Coexisting upper tract urothelial carcinoma and renal tuberculosis: A rare presentation

Tuberculosis (TB) is a global public health problem and is a leading cause of death, especially in underdeveloped and developing countries. In the majority of instances, renal tuberculosis is caused by the secondary hematogenous transmission of mycobacterium from pulmonary lesions to the renal cortex either during the initial TB infection or reactivation/endogenous reinfection of an old tuberculous focus. Upper tract urothelial carcinoma is a relatively rare kind of genitourinary malignancy and the majority of them take their origin from the urothelial lining epithelium. The co-occurrence of both renal tuberculosis and upper tract urothelial carcinoma is a rare presentation, and several theories have been proposed to demonstrate the etiological relationship between these two conditions. Here we reported a case of co-existing renal tuberculosis and urothelial carcinoma in a 54-year-old female with a remote history of treated pulmonary tuberculosis and also discussed the possible etiological root causes for their co-occurrence.

Breaking the mold: a brief review on the diagnostic and treatment approaches of mucormycosis

<p class="abstract">Mucormycosis is a severe emerging angioinvasive fungal infection that occurs predominantly in immunocompromised individuals. The incidence of this disease seems to be increasing in recent years with the emergence of new causative agents and rise of the susceptible population. The present COVID-19 pandemic has seen an un-precented increase in the number of mucormycosis cases all over the world. It has emerged as one of the most common complication of COVID-19 leading to severe morality. Uncontrolled diabetes has been postulated to be the most common underlying disease in developing countries and hematological malignancies in case of the high-income countries. Besides diabetes, chronic renal failure and tuberculosis have also been predisposed in the Indian subcontinent. Rhino-cerebral form is mostly seen in diabetics whereas the pulmonary type is the most common presentation in patients with hematological malignancies and solid organ transplant. Diagnosis and treatment of this rapidly progressive disease is equally challenging. Microscopy and culture are the cornerstone for the diagnosis, but if assisted by imaging and molecular assays, it plays an important role in the correct and early identification of the causative agent. Successful management of mucormycosis is based on an integrated approach, including reversal or discontinuation of underlying risk factors, early administration of antifungal agents, and complete removal of infected tissue and use of various adjunctive therapies.</p>

Xanthogranulomatous pyelonephritis in an eight year old male child: A case report and review of the literature.

Introduction and importanceXanthogranulomatous pyelonephritis is an extremely rare but known form of chronic pyelonephritis resulting from prolonged suppuration of the kidney. Pre-operatively, it may mimic renal tuberculosis or neoplastic lesions including renal cell carcinoma due to its vague clinical presentation, equivocal laboratory and radiological investigations. Due to its rarity and academic interest, herein we report such a rare case we recently encountered in our clinical practice.Case presentationAn-eight-year old male child patient resented to our hospital with three months history of abdominal distension associated with progressive left flank pain. Preoperative investigations including CT-scan were suggestive of nephroblastoma with differential diagnosis of clear cell sarcoma. Radical nephrectomy was performed and histopathology of the specimen confirmed the diagnosis of Xanthogranulomatous pyelonephritis. The patient fared well postoperatively and he had no symptoms in the subsequent follow up visits.Clinical discussionXanthogranulomatous pyelonephritis is a rare, severe and atypical form of chronic pyelonephritis due to infection (E. coli, Proteus) or stones. The disease may resemble renal cell carcinoma preoperatively. Thus, high index of suspicion is necessary for preoperative diagnosis.ConclusionPreoperative diagnosis of Xanthogranulomatous pyelonephritis may be a daunting task related to the rarity of its presentation. Thus, scrupulous histopathological evaluation is essential for the definitive diagnosis. Radical nephrectomy is the mainstay treatment of choice especially in diffuse cases.

Evaluation of the Biodistribution of Mesenchymal Stem Cells in a Pre-clinical Renal Tuberculosis Model by Non-linear Magnetic Response Measurements

Bone-marrow derived mesenchymal stem cells (MSCs) exert anti-tuberculosis effects due to their potential to repair damaged tissues and modulate inflammatory immune responses. MSCs were reported to be recruited to the Mycobacterium tuberculosis (Mtb) affected sites in the organism. However, due to limitations of presently applied in vivo imaging techniques the trafficking and biodistribution of MSCs in Mtb-infected organisms is not possible. In the current study MSCs were labeled with superparamagnetic iron oxide nanoparticles (SPIONs) as a negative MR contrast agent for imaging the biodistribution of MSCs in vivo. Trafficking of SPIONs-labeled MSCs was analyzed in a preclinical model of renal tuberculosis in male Chinchilla rabbits (n = 18) following intravenous administration on the days 0, 2, 3, and 7 employing a highly sensitive method of non-linear longitudinal magnetic response (NLR-M2) measurements. Within 48 h after injection, nanoparticle-labeled MSCs accumulated predominantly in lung, spleen, liver tissues, and paratracheal lymph nodes with subsequent decrease over the observation period of 7 days. The recruitment of MSCs to Mtb-affected organs was further proven by immunohistological analysis. NLR-M2 allowed the detection of SPIONs-labeled cells at low concentrations in different organs and tissues giving insights of in vivo mesenchymal stem cells trafficking in organism after TB infection.

Presentation, management and outcomes of pediatric urogenital tuberculosis: 20 years’ experience from a tertiary center

Urogenital tuberculosis (UGTB) has traditionally being a diagnosis of adulthood and is supposed to be rare in children, as it is believed that the symptoms of renal tuberculosis do not appear for 10 or more years after the primary infection. While this may be true in developed countries, where childhood pulmonary tuberculosis is a rarity nowadays. In developing countries, childhood pulmonary tuberculosis is still a major issue and hence, UGTB is not an uncommon diagnosis in younger children and adolescents in these countries. Considering this dearth of data on childhood UGTB, we retrospectively evaluated our series of children with this disease, with special emphasis on the role of surgery. To analyze the clinical presentation, management strategies and outcomes of pediatric UGTB managed in a tertiary care center. Case records of children and adolescents ≤18 years diagnosed with UGTB during the period July 1998 to June 2018at our center were reviewed. Clinical features, organ involvement, investigations, treatment and outcome of therapy were studied. There were 41 children and adolescents (M: F=22:19) identified, with a mean age of 14.8±3.9 years who fulfilled the inclusion criteria. The most common presentation was flank pain and irritative storage symptoms. Mycobacterium tuberculosis was identified on urinary examination in only 17 (41.5%) cases. Six patients were lost to follow up after initial diagnosis. A total of 45 procedures (35 primary and 10 secondary) were performed in 35 children. Initial diversion in the form of PCN and DJS were done in 11 and 12 patients respectively, of which 8 were managed with stenting alone. Surgical management was done mostly in the form of nephrectomy (15), nephrectomy along with reconstruction (5) and reconstruction only (6). On univariate analysis, factors associated with nephrectomy were poor initial function and nephrostomy as initial diversion. Overall median follow-up was 25 (IQR 15.5-74.25) months. During follow up, chronic renal failure developed in nearly 53.8% of patients who underwent major reconstruction. Urogenital tuberculosis presents with a wide spectrum of clinical features and pathological lesions. Diagnosis is often delayed because of late presentation and many children present with cicatrization sequelae. Antitubercular drug therapy and judicious application of minimally invasive diversions and surgery (both ablative and reconstructive) achieve satisfactory results in the majority of cases. Children undergoing major surgical reconstruction in particular need to be followed up rigorously and counselled about possibility of development of renal failure.

261 Unusual Case of Renal Tuberculosis in Patient With Unsuspecting Chronic Back Pain

261 Unusual Case of Renal Tuberculosis in Patient With Unsuspecting Chronic Back Pain

Features of renal tuberculosis and other extrapulmonary tuberculosis localizations, depending on the presence or absence of the diagnosis confirmation in children

Introduction. A persistent trend towards a decrease in the incidence of extrapulmonary tuberculosis is noted both in the Omsk region and throughout the Russian Federation Purpose of the study. To study anamnestic, epidemiological and clinical features of children diagnosed with renal tuberculosis and other extrapulmonary localizations, established by typical clinical and radiological manifestations or proven bacteriologically or histologically. Materials and methods. A retrospective study data was carried out from 125 children aged 0-14 years in the period 2001-2018 with registered as «extrapulmonary tuberculosis» with or without lung involvement. Group 1 consisted of 50 patients with a typical clinical and radiological picture of tuberculosis, group 2 - 75 cases, with a specific extrapulmonary process, verified bacteriologically and/or using molecular genetic methods or histology. The differences between groups were determined using Pearson's χ2 test. Results. The predominance in the structure of confirmed and established extrapulmonary process of renal tuberculosis was established, and children living in urban areas had better accessibility of diagnostic methods for verifying extrapulmonary tuberculosis (62.7%, p < 0.05). A history of concomitant pathology (94.7%, p < 0.05) and the availability of the lesion for bacteriological or histological examination (urine, pus, punctate) increased the likelihood of diagnosis verification. Most of the considered factors for renal tuberculosis in children did not differ significantly. Hyperergic results (up to 24%, p < 0.05) of immunological tests, the presence of complaints of dysuric disorders (21%, p < 0.05) prevailing in groups of children with an established diagnosis of tuberculosis kidneys, only suggest the presence of MBT-infection and do not prove the specific nature of the disease, while systematic preventive work on the examination of the risk group allows timely diagnosis of the disease at an early stage of the disease (up to 26%, p < 0.05). Conclusion. The widespread improvement of material and technical equipment, the introduction of new diagnostic techniques (PCR of urine) into routine practice, training of medical personnel in assessing prevalence issues and early detection of the disease can improve the quality of verification of this nosology.

Оперативное лечение больного туберкулезом почек, осложненным туберкулезом мочеточника

Late diagnosis of renal tuberculosis leads to complications that cannot be eliminated by treatment. A clinical observation of renal tuberculosis, complicated by total ureteral obliteration, in a comorbid patient is presented. He underwent planned bowel substitution of the right ureter. In the postoperative period, pyelonephritis developed, which was resolved by drug therapy. In this case, there is the correct tactics of outpatient urologists. When hydronephrosis was diagnosed, a nephrostomy tube was put, which allowed to preserve the kidney, Then the patient was immediately referred to a phthisiatrician to exclude urogenital tuberculosis. In the local TB dispensary, the patient did not have the opportunity to receive necessary treatment, and he was transferred to the TB Research Institute of Ministry of Health of Russia, where a reconstructive laparoscopic procedure was performed.

Une atteinte tuberculeuse rénale révélatrice d’un mal de Pott

Tuberculosisis is a serious desease, causing high morbidity and mortality. It includes frequent extra-pulmonary forms, polymorphic in their clinico-radiological presentation, resultsing in a delayed diagnosis. We report the case of a rare association of renal tuberculosis and Pott's disease. It is the case of a 19-year-old patient. He has two brothers on chronic hemodialysis. He is hospitalized for exploration of a lumbar mass and a cachectic state. Radiological imaging (MRI, scanner) suggests osteosarcoma. The renal biopsy, performed for the nephrotic syndrome, reveals the presence of a granulomatous interstitial infiltration, which suggests a tuberculosis. The anatomo-pathological study, of the excisional piece of the lumbar mass, confirms the diagnosis of tuberculous spondylodiscitis. The clinico-biological evolution, with four antituberculous therapy is favorable, except for the persistence of the glomerular syndrome.

Phlegmon of retroperitoneal tissue as a complication of cavernous renal tuberculosis

Cellulitis of the retroperitoneal tissue is a rare complication of destructive tuberculosis of the kidney. The clinical picture of the disease is characterized by the absence of characteristic symptoms, which causes certain difficulties in determining the tactics and timeliness of surgical treatment. A clinical case of newly diagnosed cavernous renal tuberculosis complicated by phlegmonous tissue of the retroperitoneal space in an elderly patient with severe comorbid pathology is presented.

Robot-assisted partial nephrectomy and nephrolithotomy for multiple lower pole calculi in an atrophic kidney

Open renal stone surgery has been largely replaced by retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (ESWL). However, when these methods fail to remove a stone or there are certain contraindications, such as pregnancy and obesity, laparoscopic, robotic or open surgery may still be indicated. In fact, robotic surgery has been increasingly used by urologists for different benign indications including chronic pyelonephritis, neglected ureteropelvic junction obstruction and renal tuberculosis. This article describes a case of robotic-assisted partial nephrectomy and nephrolithotomy for a large amount of small lithiasis in a non-functioning lower pole after failed stone clearance with a single use Boston ureteroscope owing to non-accessibility.

Comparison of laparoscopic and hand-assisted laparoscopic nephrectomy for inflammatory renal disease: which is the preferred approach?

Aims:Management of inflammatory renal disease (IRD) can still be technically challenging for laparoscopic procedures. The aim of the present study was to compare the safety and feasibility of laparoscopic and hand-assisted laparoscopic nephrectomy in patients with IRD.Patients and methods:We retrospectively analyzed the data of 107 patients who underwent laparoscopic nephrectomy (LN) and hand-assisted laparoscopic nephrectomy (HALN) for IRD from January 2008 to March 2020, including pyonephrosis, renal tuberculosis, hydronephrosis, and xanthogranulomatous pyelonephritis. Patient demographics, operative outcomes, and postoperative recovery and complications were compared between the LN and HALN groups. Multivariable logistic regression analysis was conducted to identify the independent predictors of adverse outcomes.Results:Fifty-five subjects in the LN group and 52 subjects in the HALN group were enrolled in this study. In the LN group, laparoscopic nephrectomy was successfully performed in 50 patients (90.9%), while four (7.3%) patients were converted to HALN and one (1.8%) case was converted to open procedure. In HALN group, operations were completed in 51 (98.1%) patients and conversion to open surgery was necessary in one patient (1.9%). The LN group had a shorter median incision length (5 cm versus 7 cm, p < 0.01) but a longer median operative duration (140 min versus 105 min, p < 0.01) than the HALN group. There was no significant difference in blood loss, intraoperative complication rate, postoperative complication rate, recovery of bowel function, and hospital stay between the two groups. Multivariable logistic regression revealed that severe perinephric adhesions was an independent predictor of adverse outcomes.Conclusion:Both LN and HALN appear to be safe and feasible for IRD. As a still minimally invasive approach, HALN provided an alternative to IRD or when conversion was needed in LN.

Identifying risk factors for chronic kidney disease stage 3 in adults with acquired solitary kidney from unilateral nephrectomy: a retrospective cohort study

BackgroundWe aimed to examine the risk factors for chronic kidney disease (CKD) stage 3 among adults with ASK from unilateral nephrectomy.MethodsWe retrospectively collected data from adult patients with ASK between January, 2009 and January, 2019, identified from a tertiary hospital in China. The clinical data were compared between patients who developed CKD stage 3 and those who did not develop CKD stage 3 during follow-up.ResultsIn total, 172 patients with ASK (110 men; median 58.0 years) were enrolled, with a median follow-up duration of 5.0 years. During follow-up, 91 (52.9%) and 24 (14.0%) patients developed CKD stage 3 and end-stage renal disease, respectively. Multiple regression analyses showed that age (odds ratio [OR] 1.076, 95% confidence interval [CI] 1.039–1.115, p < 0.001), diabetes (OR 4.401, 95% CI 1.693–11.44, p = 0.002), hyperuricemia (OR 2.733, 95% CI 1.104–6.764, p = 0.03), a history of cardiovascular disease (CVD) (OR 5.583, 95% CI 1.884–18.068, p = 0.002), and ASK due to renal tuberculosis (OR 8.816, 95% CI 2.92–26.62, p < 0.001) were independent risk factors for developing CKD stage 3 among patients with ASK.ConclusionsRegular follow-up of renal function is needed among adult patients with ASK. Optimal management of diabetes, hyperuricemia, and CVD may reduce their risk of CKD stage 3, especially among those that undergo unilateral nephrectomy for renal tuberculosis.

Nonpeptidal compounds from the insect Polyphaga plancyi and their biological evaluation

Five new nitrogen-containing compounds (1–3, 5, and 6), two compounds which was firstly isolated from natural origin (7 and 10), along with six known ones, were isolated from the ethanol extract of the whole bodies of Polyphaga plancyi. The structures of the new compounds including their absolute configurations at stereogenic centers were assigned on the basis of spectroscopic analyses and computational methods. Racemic 10 was separated by chiral HPLC. Biological activities of these isolates against extracellular matrix components in rat renal proximal tubular cells, EV71, COX-2, ROCK2, JAK3, and tuberculosis were evaluated. Importantly, 8 was found to be a selective Smad3 phosphorylation inhibitor.

Памяти профессора Л. Каспера – уролога-новатора и видного ученого (к 160-летию со дня рождения и 60-летию со дня смерти)

The main dates of life and scientific and practical activity of Leopold Kasper are presented. The scientific views and thoughts of the scientist are analyzed. It is shown that after graduating in 1883 from the University of Berlin he specialized in urology under supervision of G. Thompson, P. Freyer, F. Guyon, I. Albarran and L. Dittel. L. Kasper was the founder of a large German urological school, the author of a large number of scientific works, including study dedicated to cystoscopy, endoscopic procedures, functional diagnosis of renal disorders, treatment of renal tuberculosis and urolithiasis, prostate diseases, transurethral galvanocaustics of bladder tumors, etc. He designed a special catheterization cystoscope (1895), which allowed for the first time to study differential functional ability of each kidney. It greatly facilitated the recognition and treatment of surgical pathologies of kidneys and upper urinary tract. In addition, L. Kasper improved and implemented into practice a functional renal test with fluoridzine and cryoscopic examination of urine obtained from each kidney separately after ureteral catheterization.