How it develops
Mycobacteria enter the kidneys through the bloodstream from the primary focus, most often the lung, sometimes many years after it. Small foci are formed in the cortex of the kidney, which remain in an inactive state for a long time.
When immunity decreases, the process is activated: the lesions enlarge, merge, and destroy tissue with the formation of cavities - cavities. The infection then travels down the urinary tract, affecting the ureter and bladder.
It is the descending nature that explains the clinical picture: cicatricial narrowings with hydronephrosis form in the ureter, and persistent inflammation develops in the bladder with a decrease in its volume - the so-called small bladder. In men, the process can affect the prostate and epididymis.
Symptoms
- Long-term asymptomatic course in the early stages
- Frequent, painful urination that does not respond to standard treatment
- Persistent lower back pain
- Blood in urine
- Constant changes in urine tests with negative cultures for normal flora
- Decreased bladder capacity with very frequent urination in small portions
- Low-grade fever, night sweats, weakness, weight loss
- In men - dense painless enlargement of the epididymis, scrotal fistula
- Infertility
- With bilateral damage - signs of renal failure
Who's at risk
- Previous history of tuberculosis of any location
- Contact with a patient with active tuberculosis
- HIV infection and other immunodeficiency conditions
- Diabetes mellitus
- Taking immunosuppressive drugs and glucocorticoids
- Chronic kidney disease and dialysis
- Unfavorable social and living conditions
- Patients after organ transplantation
Diagnostics
- General urine analysis - leukocyturia, erythrocyturia, acid reaction, protein
- Repeated urine cultures for normal flora - characterized by lack of growth
- PCR of urine for the DNA of Mycobacterium tuberculosis
- Urine culture for mycobacteria on special media - three times, morning portions
- Microscopy of urine sediment for acid-fast bacteria
- Mantoux test, Diaskintest, interferon gamma release tests
- CT urography - cavities in the kidney, calcifications, ureteral strictures, reduced bladder
- Excretory urography
- Cystoscopy with biopsy - characteristic tuberculate rashes and ulcers of the mucous membrane; biopsy provides morphological confirmation
- X-ray of the chest organs - search for a pulmonary focus
- Ultrasound of the scrotum and TRUS of the prostate in men
- Spermogram for suspected genital lesions
Treatment
- Long-term multicomponent anti-tuberculosis therapy is the basis of treatment; prescribed and monitored by a phthisiatrician
- Strict adherence to the regimen and timing: interruption of the course leads to drug resistance
- Ureteral stenting or nephrostomy for strictures and urinary outflow obstruction
- Reconstructive surgery on the ureter after completion of the main course
- Augmentation cystoplasty for small bladder
- Nephrectomy for a completely destroyed, non-functioning kidney
- Epididymectomy for lesions of the epididymis
- Monitoring and monitoring of kidney function during treatment
- Examination of contact persons
Prevention and surveillance
- Timely detection and comprehensive treatment of tuberculosis of any location
- Examination of the urinary system in people who have had pulmonary tuberculosis in the event of urological complaints
- Monitoring urine tests during long-term use of immunosuppressive drugs
- Compensation for diabetes mellitus
- Fluorography and preventive examinations
- After completion of treatment - long-term observation with monitoring of ultrasound, urine tests and kidney function
- Monitoring the formation of ureteral strictures in the long term
Where to get examined in Tashkent
The urological part of the diagnosis includes CT urography, cystoscopy with biopsy and specific urine tests, and treatment is always carried out in conjunction with the TB service.
In Tashkent, a urological examination for suspected tuberculosis of the urinary system, as well as surgical treatment of its consequences - ureteral strictures and a damaged kidney - are carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If you are treating “chronic cystitis” for more than six months, and urine cultures are always sterile, be sure to ask your doctor to rule out tuberculosis of the urinary system. This diagnosis is made late precisely because it is rarely thought about. Clinic contacts are below.
