Urinary tuberculosis: a cohort of 79 adult cases

Abstract

We aimed to investigate the demographic, clinical, diagnostic, treatment and outcome features of patients with urinary tuberculosis (UTB). Patients with UTB admitted to seven separate centers across Turkey between 1995 and 2013 were retrospectively evaluated. The diagnosis of UTB was made by the presence of any clinical finding plus positivity of one of the following: (1) acid-fast bacilli (AFB) in urine, (2) isolation of Mycobacterium tuberculosis, (3) polymerase chain reaction (PCR) for M. tuberculosis, (4) histopathological evidence for TB. Seventy-nine patients (49.36% male, mean age 50.1 ± 17.4 years) were included. Mean time between onset of symptoms and clinical diagnosis was 9.7 ± 8.9 months. The most common signs and symptoms were hematuria (79.7%), sterile pyuria (67.1%), dysuria (51.9%), weakness (51.9%), fever (43%) and costovertebral tenderness (38%). Cystoscopy was performed in 59 (74.6%), bladder biopsy in 18 (22.8%), kidney biopsy in 1 (1.26%) and nephrectomy in 12 (15.2%) patients. Histopathological verification of UTB was achieved in 12 (63.1%) patients who undergone biopsy and in 100% of those undergone nephrectomy. Mycobacterium tuberculosis was isolated in the urine of 50 (63.3%) cases. Four-drug standard anti-TB treatment was the preferred regimen for 87.3% of the patients. Mean treatment duration was 10.5 ± 2.7 months. Deterioration of renal function occurred in 15 (18.9%) patients two of whom progressed to end-stage renal disease and received hemodialysis. Only one patient died after 74-day medical treatment period. Cases with UTB may present with non-specific clinical features. All diagnostic studies including radiology, cyctoscopy and histopathology are of great importance to exclude UTB and prevent renal failure.

Urinary Tract Tuberculosis

“…In UTTB, a history of pulmonary TB is present in 17.7-25.8% [14][15][16]. The time interval between the onset of primary pulmonary TB and development of GUTB has a mean interval of 3-10 years in more than 50% of patients [14,15]. In frequency, renal involvement is the most common finding following by ureteric and bladder involvement [16].…”

“…The proportion of immune-compromising conditions, such as malignancy, diabetes mellitus, chronic renal failure, and immunosuppressive drug use, are found as 46.7% [14]. The incidence of TB has been estimated to be as much as 10-fold higher among renal failure patients than among the general population [17].…”

“…There are several diagnostic methods for this entity. Here, we review the most common procedures used: (1) ZN staining and cultures isolation for Mtb in urine, (2) PCR for Mtb, (3) imaging studies, and (4) histopathological evidence for TB [14].…”

“…Clinical judgment and the index of suspicion for TB are critical in making a decision to initiate treatment [9,14]. Therapy should be initiated promptly even before the results of AFB smear microscopy, molecular tests, and mycobacterial culture are known.…”

“…Therapy should be initiated promptly even before the results of AFB smear microscopy, molecular tests, and mycobacterial culture are known. It is particularly important in cases admitted with episodes of cystitis concomitant with sterile pyuria and progressive renal parenchymal damage not related to other clinical diseases [14]. If the diagnosis has been made while renal function still remains, it may be possible to arrest the fall in glomerular filtration rate or even produce improvement, using a combination of anti-TB treatment and corticosteroids [21].…”