Tuberculosis - is an infectious disease with a chronic course, which is caused by Mycobacterium Koch. Depending on which organs are affected, tuberculosis is divided into pulmonary and extrapulmonary forms. Tuberculosis of the kidneys - the most common variant of extrapulmonary disease.
How is renal tuberculosis
In most cases of tuberculosis
Tuberculosis - a full recovery is not guaranteed
genitourinary system is secondary. This means that a person has been infected with Mycobacterium early and moved primary tuberculosis. Bacillus stored in a small amount in the lungs or the lymph nodes. Then, the bacteria enter the bloodstream into the kidneys of both vessels, namely in their glomerular apparatus. The latter is located in the cortex (outer) layer of the kidney, and it begins to form urine.
Kidney infection develop an average of eight years after the onset of symptoms of primary tuberculosis
Primary tuberculosis - a negative contact with mycobacteria
. In the cortex are formed tubercular foci. The pathological process is actively developing to the kidney, which disrupted the flow of urine for any reason. Predisposing factors of renal tuberculosis are:
- Pyelonephritis;
- Nephroptosis;
- Congenital malformations of the urogenital organs;
- Gynecological diseases;
- Pregnancy.
In other kidney infection is inactive (dormant) state. Sometimes tuberculosis foci may even disappear on their own.
If a person's immunity is lowered, the tubercular process extends to the medulla of the kidney. Inflammation of the renal papillae, a condition called tuberculous papillita. With the progression of the disease papilla ulcerate and kidney tissue is destroyed even more. The body forms a cavity (cavities), that is developing cavernous tuberculosis of the kidney.
Around cavities appear multiple foci of infection and the formation of new cavities which are later joined together. They accumulate a lot of pus, so there is a formation of tuberculous pyonephrosis. In the later stages of the disease the infection spreads to the ureters and bladder
Urinary bladder - structure and function
.
Signs
Most renal tuberculosis occurs without any symptoms. When the infectious changes affect only the cortex, the patients concerned about malaise, weakness and dull pain lower back. Sometimes there is an increase in body temperature. In urinalysis changes may not be, but is sometimes observed protein, erythrocytes and leukocytes. In some cases, can be identified in urine sticks Koch.
When papillitis signs of intoxication are more pronounced. If there is a blockage of the ureter by a blood clot or pus, then there are very strong pain (renal colic).
Cavernous tuberculosis When the body temperature rises to 38ºC and above. Chills, persistent dull pain in the lumbar region and frequent bouts of renal colic - the characteristics of this form of the disease. If the inflammation goes to the ureters and bladder, it becomes more frequent urination and becomes painful.
Diagnostics
Detection of mycobacteria in the urine - the most important criterion for diagnosis. It is important that patients do not take any drugs to treat tuberculosis
Treatment of tuberculosis - a lengthy process and requires constant monitoring
within three days prior to the study. The patient should take the morning portion of urine for three days. In the laboratory, this makes crop biological fluid, and determining whether there is bacterial growth on nutrient media.
In some cases, when it is difficult to establish the correct diagnosis, conduct special tests. To do this, the patient is injected subcutaneously with tuberculin - a drug that helps to determine whether there is in the human antibodies to mycobacteria. If the background of the sample overall deteriorating human, and signs of kidney damage becomes more pronounced, this is evidence of tuberculosis process in the urinary system. After the introduction of the tuberculin necessarily repeat urine to detect it leukocyte cylinders of red blood cells, protein, and sticks Koch.
X-rays of the kidney helps to detect the disease process and obtain information about its prevalence. Ultrasound examination also allows you to assess the condition of the kidneys and to identify cavities and foci of calcification, but this method of diagnosis is a subsidiary. Computer and Magnetic resonance imaging was performed in order to learn how amazed kidney tissue. This information will be needed during the surgery.
Treatment
Treatment of patients with renal tuberculosis should be carried out in the TB dispensary. It is conservative and operative (surgical).
Conservative treatment will be effective only during the early stages of the disease. It involves the simultaneous use of various anti-TB drugs. Typically, renal tuberculosis are assigned:
- Isoniazid;
- Rifampicin;
- Ethambutol;
- Prothionamide;
- Pyrazinamide.
That treatment was more effective with the listed drugs commonly prescribed drugs are the fluoroquinolones (ofloxacin, ciprofloxacin), streptomycin and tubazid. The duration of intake of these funds should be at least nine months. In order to determine how successfully being treated, regularly perform urine tests, ultrasound and X-ray studies.
In the later stages of renal tuberculosis patients should conduct surgery. Depending on the prevalence of tuberculosis process, the following operations:
- Partial nephrectomy - removal of the affected part of the body;
- Cavernotomy - autopsy pathological cavity in the kidney and remove the contents;
- Kavernektomiya - opening of the cavity and the excision of its walls;
- Nephrectomy - removal of the kidney. This operation is carried out in case of damage tuberculous processes of the body.
After surgery for a couple of years being treated with anti-TB agents. This makes it possible to destroy the remaining mycobacteria in a patient.
Prevention of renal tuberculosis is to prevent the development of TB of the lungs, bones and other organs and its early detection. Treatment of diseases of the urinary system and strengthen the immune defenses reduce the likelihood of kidney damage mycobacteria.
Alexander Chernov
