Tuberculosis of kidneys
Tuberculosis of kidneys () – the extra pulmonary infection caused by mikobakteriya of tuberculosis and affecting a kidney parenchyma. The clinic of tuberculosis of kidneys is not specific; can include an indisposition, subfebrilitt, waist pain, a makrogemmaturiya, a dizuriya. Tuberculosis of kidneys is diagnosed by means of laboratory analyses of urine, a tuberkulinodiagnostika, ultrasonography of kidneys, urography, a retrograde ureteropiyelografiya, a nefrostsintigrafiya, a morphological research. Treatment of tuberculosis of kidneys includes purpose of specific antitubercular therapy; at destructive process in kidneys performance of a kavernektomiya or nefrektomiya can be required.
Tuberculosis of kidneys
Among organ extra pulmonary defeats tuberculosis of kidneys is the most common form of a disease and meets in urology in 30-40% of observations. Originally at tuberculosis of kidneys there is a defeat of a cortical layer of body. Further progressing of an infection is followed by disintegration of fabrics, formation of cavities and cavities in a kidney parenchyma, violation of functioning of kidneys. In hard cases development of a tubercular pionefroz (purulent fusion of renal fabric), involvement in infectious process of a lokhanka, a mochetochnik, a bladder, genitals is observed.
At tuberculosis of kidneys the genital tuberculosis affecting a prostate, testicles, appendages of testicles at men rather often develops (tubercular prostatitis, orkhit, an epididymite); women have appendages, pipe fallopiyeva, a uterus (tubercular salpingooforit, salpingit, an endometritis).
Reasons of tuberculosis of kidneys
Causative agents of tuberculosis of kidneys are tuberculosis mikobakteriya (M. of tuberculosis). As a rule, tuberculosis of kidneys arises at patients with the started pulmonary or bone tuberculosis after 3-10 years of a course of primary tubercular process.
Penetration of an infection into a kidney happens in mainly hematogenic way. Getting with blood current to the glomerular device of a kidney, mikobakteriya form the multiple smallest tubercular centers. At good local and general resistance to an infection and the small sizes of primary centers, the last can be exposed to full return development. At frustration of an urodinamika and haemo dynamics, and also the reduced protective forces from a cortical layer the infection extends in brain substance, causing a specific inflammation of kidney nipples - tubercular papillit.
In process of further development of tuberculosis of kidneys all thickness of kidney pyramids is involved in process, there is a kazeozny disintegration of the last that is followed by formation of the cavities isolated or reported with a cup lokhanochnymi complexes. Progressing of tuberculosis of kidneys can lead to formation in a kidney parenchyma of multiple cavities (a polikavernozny form) and to development of a pionefroz. The subsequent healing of cavities proceeds with calcification of the kazeozny centers in which, however, viable mikobakteriya of tuberculosis can remain.
Secondary involvement of a bladder, mochetochnik and cup complexes is connected with the lifogenny or urinogenny mechanism of spread of a tuberculosis infection. Development of tuberculosis of kidneys, as a rule, happens against the background of the available local infectious or urodinamichesky processes – chronic pyelonephritis, stones of kidneys, etc.
Classification of tuberculosis of kidneys
In clinical urology the classification considering kliniko-radiological features of tuberculosis of kidneys is accepted. According to this classification allocate:
- The tuberculosis of a kidney parenchyma which is followed by formation of the multiple centers in a cortical and medullary layer of a kidney.
- Tubercular papillit, proceeding with defeat of kidney nipples.
- The Kavernozny tuberculosis of kidneys which is characterized by merge of the destructive centers to encapsulation (a band form).
- Fibrous the tuberculosis of kidneys which is followed by an obliteration of cups with formation in them the closed destructive and purulent cavities.
- Omelotvoreniye (calcification) of a kidney which is expressed in formation of the limited pathological centers with a large amount of salts of calcium (kazey, tuberkuly).
Symptoms of tuberculosis of kidneys
The clinic of tuberculosis of kidneys is not followed by patognomonichny symptoms. At early stages tuberculosis of kidneys can have a latent current or be characterized by violations of the general health: an easy indisposition, bystry fatigue, subfebrilny temperature, the progressing weight loss. Destructive changes in kidneys are followed by emergence of the bezbolevy total gematuriya caused by an erosion of vessels at an ulceration of kidney nipples. Bleeding quite often is replaced by the piuriya demonstrating development of a piyelit or pyelonephritis.
At kavernozny tuberculosis of kidneys symptoms of infectious intoxication, waist pain are noted. Pain is, as a rule, expressed moderately, has the aching stupid character, however at violations of outflow of urine can progress to renal colic. Bilateral violation of an urodinamika is followed by symptoms of a chronic renal failure.
At tubercular damage of a bladder (tubercular cystitis) the dizurichesky phenomena – imperative desires join an urination, a pollakiuriya, a stranguriya, constant pain over a bosom, a periodic makrogematuriya. In the started stages of tuberculosis of kidneys arterial hypertension quite often develops.
Diagnosis of tuberculosis of kidneys
Considering that tuberculosis of kidneys can proceed asymptomatically or in the form of various clinical options, in diagnostics paramount value gets carrying out laboratory and hardware and tool researches. At suspicion of tuberculosis of kidneys conducting tuberkulinovy test and consultation of the phthisiatrician is shown. When collecting the anamnesis find out the fact of presence of pulmonary tuberculosis at the patient and his relatives, contacts with tubercular patients. At thin patients in some cases it is possible to propalpirovat a dense, hilly kidney. The pronounced symptom of Pasternatsky is defined.
As characteristic changes of the general analysis of urine at tuberculosis of kidneys serve permanent sharply sour reaction, a leykotsituriya, a proteinuria, an eritrotsituriya, a piuriya. It is reliable identification of a mikobakteriuriya which is found by means of bacteriological crops of urine or the PTsR-research allows to judge existence of tuberculosis of kidneys. Carrying out IFA allows to find antibodies to tuberculosis.
In certain cases implementation of provocative tests with tuberkuliny is required. After hypodermic introduction of a tubercular anti-gene there is an exacerbation of tuberculosis of kidneys that is followed by the expressed proteinuria, a piuriya and a mikobakteriuriya. Ultrasonography of kidneys at their tubercular defeat allows to reveal cavities, the calciphied centers, to estimate extent of involvement of a kidney parenchyma and dynamics of regress of tuberculosis of kidneys under the influence of the carried-out therapy.
X-ray research of kidneys (survey urography, excretory urography, retrograde ureteropiyelografiya and antegradny piyelografiya) parenchyma and cup the device of kidneys, mochetochnik, a bladder help to estimate in a complex a condition. Performance of a kidney angiography allows to define an intra organ angioarkhitektonika in case of need of a kidney resection.
KT of kidneys and MRT have ample diagnostic opportunities concerning detection of tuberculosis of kidneys. Data on a functional condition of kidneys at tuberculosis are obtained by means of a radio isotope nefrostsintigrafiya.
The kidney biopsy at tuberculosis is dangerous by a dissemination of infectious process, however according to indications the tsistoskopiya with a biopsy mucous a bladder can be carried out. The morphological research of a biopatat of a bladder in some cases allows to find huge cells of Pirogov-Langgansa even in the absence of visual changes of mucous. Differential diagnostics at tuberculosis of kidneys is necessary with gidronefrozy, nonspecific pyelonephritis, a spongy kidney, megakalikozy, polikistozy kidneys.
Treatment of tuberculosis of kidneys
Treatment at tuberculosis of kidneys can be medicamentous and combined (surgical and medicamentous). Drug treatment of a nefrotuberkulez includes purpose of specific antitubercular medicines of different groups for a period of 6 up to 12 months (rifampicin, an isoniazid, , pyrazinamide, , streptomycin, etc.). The combination of medicines of the first row to ftorkhinolona is perspective (ofloksatsiny, ciprofloxacin, lomefloksatsiny). The specific chemotherapy at tuberculosis of kidneys is supplemented with purpose of vasoprotectives, NPVS preventing cicatricial wrinkling of renal fabric. It is necessary to consider that long-term treatment by anti-tubercular medicines can lead to a heavy intestinal dysbiosis, allergic reactions.
At violation of outflow of urine from a kidney installation of a mochetochnikovy stent or carrying out a nefrostomiya is required. In case of development of local destructive process in a kidney conservative therapy is supplemented with sanitation of the struck segment (kavernotomiy) or partial resection of a kidney (kavernektomiy). At total destruction of body the nefrektomiya is shown.
Forecast and prevention of tuberculosis of kidneys
The main predictive criterion at tuberculosis of kidneys is the disease stage. Early identification of a nefrotuberkulez, lack of destructive processes in a cup lokhanochnoy to system, mochetochnik and a bladder against the background of adequate specific chemotherapy can be followed by full treatment. In respect of the forecast bilateral tuberculosis of kidneys with the expressed destruction of a kidney parenchyma is adverse.
All patients who had tuberculosis of kidneys are on the dispensary account at the phthisiatrician and the nephrologist with periodic inspection. As criteria of an izlechennost of tuberculosis of kidneys serves normalization of indicators of urine, lack of a recurrence of a nefrotuberkulez according to radiological data within 3 years. The prevention of tuberculosis of kidneys consists in observance of measures specific (vaccination against tuberculosis) and nonspecific prevention pulmonary tuberculosis.