DIAGNOSTIC DELAY IN RENAL TUBERCULOSIS

Abstract

Introduction: Tuberculosis (TB) of the urinary system is
the second most common after pulmonary system.
Urinary tuberculosis can mimic a number of diseases,
hence its diagnosis is not very easy. A case is presented
here where only after repeated investigations was the
suspicion of renal tuberculosis aroused and diagnosis
established by laboratory and imaging investigations.
Materials & Methods: A 35 year female Afghan patient
with fever and recurrent lower urinary tract symptoms
was admitted to Rehman Medical Institute (RMI) hospital
in first week of September 2013. She had sterile pyuria not
responding to usual antibiotics. Centrifuged deposit of her
early morning urine upon microscopy showed a number of
Acid Fast Bacilli after Ziehl-Neelson (ZN) staining.
Mycobacterium tuberculosis was grown on solid Lowenstein-
Jensen (L-J) medium and detected in liquid Mycobacterium
Growth Indicator Tube (MGIT) medium. The strain was
confirmed by TB Identification kit. Ultrasound showed
hydronephrosis; ureteroscopy picked up suspected
tubercular lesions in ureters and renal pelvis, hence she
was stented and started on anti-TB medication.
Results: Upon follow up, marked improvement was
observed.
Conclusions: Tuberculosis of the urinary tract should
strongly be considered in patients with recurrent Urinary
Tract Infections (UTI) and sterile pyuria not responding to
antibiotics. The signs and symptoms of renal tuberculosis
mimic those of other renal infections.
Keywords: Tuberculosis, Renal; Tuberculosis, Urogenital;
Mycobacterium tuberculosis; Urinary Tract Infections.