Renal tuberculosis - Nephrophthisis

Japanese: 腎結核 - じんけっかく（英語表記）Nephrophthisis

What is the disease?

This is a disease in which tuberculosis bacteria spread from the initial infection focus in the lungs or tuberculous focus in other organs via the bloodstream to the kidneys, forming initial tuberculous lesions in the renal parenchyma.

Initial lesions progress slowly over several years, Necrosis ( Replying to @sarah_mcdonald ) The tissue becomes cheese-like. Caseation ( Kanrakuka ) As the disease progresses, tuberculosis foci form in the ureters, bladder, urethra, etc., and these are collectively called urinary tract tuberculosis.

The lesion Calyx ( Jinpai ) , Renal pelvis ( Jinu ) When Pyuria ( Nounyo ) and tuberculosis in the urine. constriction ( Kyosaku ) by Hydronephrosis ( Water supply ) This can cause back pain and lead to the formation of kidney stones.

What is the cause?

It is an infection of the urinary tract (kidneys, ureters, bladder, and urethra) caused by the human tuberculosis bacillus.

How symptoms manifest

Hydronephrosis can cause back pain, and if the lesion extends to the ureter or bladder, bladder irritation symptoms ( Frequent urination ( Reception ) , pain when urinating, feeling of residual urine, etc.) Fatigue ( Health test ) , Easy ( stomach ) Nonspecific symptoms such as fatigue (easily tired), low-grade fever, weight loss, loss of appetite, and night sweats may also be present.

Cystitis with pyuria may also be observed that is resistant (ineffective) to standard antibiotic therapy.

Testing and diagnosis

The most important finding in urine is sterile pyuria (white blood cells are present in the urine, but no bacteria are present; bacteria cannot be detected by standard Gram staining or simple staining microscopic examination or culture testing). Acid-fast bacillus staining (Ziehl-Nielsen staining) and acid-fast bacillus culture are required to confirm the presence of tuberculosis bacteria. Polymerase chain reaction (PCR) testing is also possible. Recently, QTF2G (Quantiferon TB2G) has also been used for diagnosis.

Imaging diagnosis includes ultrasound, CT (Figure 3), and excretory or retrograde urography. atrophy ( Ishku ) , connected to the renal calyx abscess ( Use ) There are cavities and calcification in the kidneys.

Treatment methods

Treatment is the same as for pulmonary tuberculosis. Rest and combination therapy with anti-tuberculosis drugs are the basics.

Antituberculosis drugs used are isoniazid (INF), rifampicin (RFP), streptomycin (SM), pyrazinamide (PZA), etc. The treatment period is generally six months.

Atsushi Kurusu

Figure 3. Left renal tuberculosis (CT image)
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Figure 3. Left renal tuberculosis (CT image)

Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな病気か

　結核菌が肺の初感染巣、あるいは他の臓器の結核病巣から血行性に腎に散布され、腎実質に初期結核病変を形成する病気です。

　初期病変は数年以上の経過でゆっくり進行し、壊死(えし)した組織がチーズ状になる乾酪化(かんらくか)や空洞を生じ、尿中に結核菌が排出されるようになります。さらに進行すると尿管、膀胱、尿道などに結核病巣を形成し、これらを総称して尿路結核と呼びます。

　病変が腎杯(じんぱい)、腎盂(じんう)に及ぶと膿尿(のうにょう)や結核菌尿がみられ、進行すると尿管狭窄(きょうさく)による水腎症(すいじんしょう)で背部痛などを起こしたり、腎結石が形成されたりします。

原因は何か

　ヒト型結核菌による尿路（腎臓、尿管、膀胱、尿道）感染です。

症状の現れ方

　水腎症による背部痛や、病変が尿管や膀胱に及ぶと、膀胱刺激症状（頻尿(ひんにょう)、排尿痛、残尿感など）がみられます。それ以外には、全身倦怠感(けんたいかん)、易(い)疲労感（疲れやすさ）、微熱、体重減少、食欲不振、寝汗などの非特異的症状がみられることもあります。

　また、通常の抗菌薬療法に抵抗する（効果がない）膿尿を伴う膀胱炎が認められることもあります。

検査と診断

　尿所見において、無菌性膿尿（尿中には白血球を認めるが、細菌を認めないこと：通常のグラム染色や単染色の検鏡および培養検査では細菌が検出できない）が最も重要な所見です。結核菌の証明には抗酸菌染色（チール・ニールセン染色）や抗酸菌培養が必要です。ポリメラーゼ連鎖反応法（PCR法）による検査も可能です。最近ではQTF2G（クォンティフェロンTB2G）も診断に使用されます。

　画像診断としては、超音波、CT（図3）、排泄性または逆行性尿路造影検査が行われます。水腎症、腎盂腎杯の破壊像（虫喰い像）、腎の萎縮(いしゅく)、腎杯と交通のある膿瘍(のうよう)や空洞、腎の石灰沈着を認めます。