Tuberculosis of the kidney and urinary tract

Koch's rod( microbacterium tuberculosis) is a characteristic causative agent that causes tuberculosis of the kidneys and urinary tract. Primary infection occurs in the lungs and is localized there. Basically, this process takes place one-sidedly. Only 30% of patients experience bilateral kidney damage. The time interval from the onset of the disease to the manifestation of tuberculosis is eight years. Pathogens of tuberculosis can also penetrate the body through the tonsils( lymphogenous) and the gastrointestinal tract.

Classification

The first stage is infiltrative, i.e. Not destructive tuberculosis of the kidney, the second is the initial destruction - single caverns( diameter does not exceed 1 cm) or papillitis, in the third stage there is infection of one of the kidney sites - limited destruction, the fourth stage is characterized by total, as well as subtotal destruction( tuberculous pyonephrosis, Kidney or polycavernous tuberculosis of two sites( segments)).

Symptoms and clinical manifestations of

Clinical manifestations of the disease depend on its stage and extent of localization. At an early stage, the symptoms do not appear. Later, at the onset of destruction, there are signs of chronic toxic poisoning and low back pain. When moving the pathological process in the lower organs, there are signs of cystitis, with concomitant dysuria, which can not be treated with antibacterial drugs. This disease can be veiled in the guise of other ailments such as chronic cystitis and pyelonephritis, bladder tumor or kidney tumors, etc.

Diagnosis of

This process begins with the collection of anamnesis and complaints. Anamnesis gives more information than complaints of the patient, becauseThey may be uncharacteristic for this disease. When collecting an anamnesis, it is taken into account whether there was contact with patients with tuberculosis and the presence of tuberculosis of other organs earlier.

Clinical examination using physical instruments gives little information. Approximately 50% of men with tuberculosis of the reproductive system can be diagnosed with tuberculosis of the kidney with the help of palpation of external genitalia, seminal vesicles and prostate. Laboratory methods show the presence of mycobacteria tuberculosis in the urine, manifested by hematuria, proteinuria, pyuria and pathognomonic trait. Methods that provide extended information of the quantitative index of leukocyturia are the analysis by Nichiporenko, de Almeida, Kakowski-Adiss, Ambiurge. Mycobacterium tuberculosis is detected in approximately 70-80% of the patients. Make a subcutaneously modified Koch test( tuberculosis-provocative test).

Using an X-ray, the volume of pathology in the kidney is determined. The studies are carried out with the help of retrograde pyelography, excretory urography( with contrast substance IV) and survey radiography. Downward cystography is performed to detect bladder lesions. Angiography with kidney tuberculosis in case of a planned resection of the kidneys. Ultrasound and computed tomography are performed in order to obtain a picture of the morphological state of the kidneys.

Treatment of

Therapy depends on the stage of the disease. Surgical intervention is carried out at the third and fourth stages.

Conservative treatment is used at all stages of the disease - the use of drugs of three groups in the period from 10 months to one year: preparations of the GINK group and PASK and antibiotics. In general, rifampicin, protionamide, isoniazid, ethambutol, cycloserine, streptomycin, PASC are prescribed.

Preventive methods of preventing scars in the ureter before were biostimulants, hormones of the adrenal cortex and physiotherapy. At present, a catheter is inserted into the lumen of the ureter to improve the outflow of urine from the kidney. It is necessary to follow a diet, sanatorium treatment, treatment and climatotherapy.

Operative methods of treatment include resection of the kidney, cavernotomy, nephrectomy and cavernectomy. Reconstructive operations are performed, and at the fourth stage of the disease nephrectomy is performed.