Mycobacterium tuberculosis, getting into the body, infects lung tissue. Among the extrapulmonary manifestations of tuberculosis, the kidneys are most frequently affected. Changes occur in the cortical layer of the kidney. As the disease progresses, the kidney tissue undergoes decay with the formation of cavities and cavities in the parenchyma, which leads to irreversible impairment of kidney function. Severe cases are characterized by the development of tuberculous pyonephrosis with involvement in the process of the pelvis, bladder, ureter and genital organs. What is the difficulty in diagnosing tuberculosis in the kidneys? How does the disease manifest itself?
Under what conditions does kidney tuberculosis develop?
Renal tuberculosis often provokes the development of genital tuberculosis, which affects the fallopian tubes, appendages and uterus in women, orchitis, tuberculous prostatitis develops in men.
Renal tuberculosis develops against the background of advanced bone or lung tuberculosis, approximately several years after primary tuberculosis. Infection in the kidney penetrates the hematogenous route. The infectious agent, getting into the glomerular apparatus of the kidney, forms small tuberculous foci. If a person's body resistance is not reduced, then small foci can disappear on their own by reverse development. Disorders of hemodynamics and urodynamics, as well as a decrease in local and general body defenses, contribute to the spread of infection to the medulla, provoking the development of tuberculous papillitis (inflammation of the renal vessels).
Further development of tuberculosis of the kidneys is accompanied by the involvement of the entire thickness of the renal pyramids and their caseous decay. After that, complexes are formed cup – pelvis caverns. Progression is accompanied by the formation of multiple cavities and the development of pyonephrosis. How this manifests itself, read further on estet-portal.com. The healing of cavities is carried out with the calcification of caseous foci, in which viable Mycobacterium tuberculosis can persist.
Clinical manifestations of tuberculosis of the kidneys. Symptoms of a destructive process in the kidneys
Clinical manifestations of kidney tuberculosis do not have pathognomonic specific signs. The early stages can be manifested by slight malaise, weakness, weight loss, subfebrile temperature.
The beginning of destructive processes in the renal tissue is characterized by the appearance of total hematuria, which is not accompanied by pain. The appearance of blood in the urine is caused by erosion of the walls of blood vessels with ulceration of the renal papillae. After hematuria, pyuria may develop, which indicates the development of pyelonephritis or pyelitis.
Cavernous tuberculosis of the kidneys is accompanied by infectious intoxication and back pain. Pain is moderate, dull aching in nature. Violation of the outflow of urine can provoke renal colic. With a bilateral violation of urodynamics, chronic renal failure develops.
Bladder damage in kidney tuberculosis is accompanied by the following symptoms:
- imperative urge to urinate;
- stranguria;
- pollakiuria;
- recurrent gross hematuria;
- pain over the womb.
What diagnostic methods will help detect kidney tuberculosis?
Since kidney tuberculosis can be asymptomatic or in the form of various clinical variants, the hardware is of great importance in the diagnosis – instrumental and laboratory research.
At the first suspicion of kidney tuberculosis, a tuberculin test and a consultation with a phthisiatrician are performed. On examination, in some cases, in lean patients, it is possible to palpate a dense tuberous kidney, Pasternatsky's symptom is brightly positive. In the analysis of urine, there is a sharply acidic reaction, leukocytes, protein, erythrocytes, pyuria. The diagnosis is confirmed by the detection of Mycobacterium tuberculosis in the urine by bacteriological culture or PCR – research.
Ultrasound of the kidneys makes it possible to identify the number and size of cavities, the degree of parenchymal involvement in the process. X-ray examination allows a comprehensive assessment of the state of the parenchyma cup – pelvic apparatus of the kidneys, and also determines the intraorgan architectonics.
In case of kidney tuberculosis, a biopsy is dangerous for the development of dissemination of the infectious process, however, according to strict indications, cystoscopy is performed with a biopsy of the bladder mucosa.
Differential diagnosis is carried out with nonspecific pyelonephritis, hydronephrosis, spongy kidney, polycystic kidney disease and megakalosis. Treatment of tuberculosis of the kidney is drug-induced or combined, which combines surgical and & nbsp; medical approach.
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