Renal tuberculosis – state and urinalysis

During the primary generalization of tuberculosis process may be affected both kidneys. At the same time in their cortex are formed tiny TB foci. In most cases, the high resistance the body is their healing. At low body resistance or high virulence of infection of complete healing of tuberculosis foci in the renal cortex does not occur, or process progresses, or becomes slow character.

Typically, the process is developed in only one kidney, and in the other it does not decay and clinical manifestations.

Thus, renal tuberculosis, It is pathogenic and pathologic against two-way process, clinically initially occurs as a one-sided. Bilateral renal involvement occurs in about 1/3 cases of renal tuberculosis.

The main route of infection with Mycobacterium tuberculosis is the kidney hematogenous. The possibility of lymphatic and urinogenous infection most authors excluded.

In the early stages of the disease tubercles are located mainly in the cortex, where they are often exposed to scarring. Buhorky, localized in the renal medulla, in the renal papilla, renal sinus or arch cups, merge and split caseous. In most cases, the contents of the cavity through the small fistulous course breaks in the urinary tract. Thus Mycobacterium tuberculosis and pus fall into the renal pelvis, ureters and bladder. The progressive destruction of TB can lead to complete destruction of the kidneys and the tuberculosis pyonephrosis.

The development of pathological changes is determined by a number of factors, the most important of which are the body's resistance, and treatment. When the damping process can occur calcification foci caseation. Often under the influence of treatment comes from emptying caverns curd, their complete cleansing and elimination of specific changes in the wall of the cavity.

Tuberculosis of the kidneys often occurs under the guise of other urological diseases or symptoms, until, until the process spread to the bladder. This develops pielit with pyuria.

Impurities from leukocyte urine becomes turbid, and when it is defending a yellowish purulent sediment, often voluminous, especially in tuberculous pyonephrosis. If untreated tuberculosis kidney this symptom occurs almost 100 % cases.

Especially characteristic for tuberculosis resistant Piura, not susceptible to the usual (nonspecific) antibiotic therapy, conducted over the alleged cystitis or pyelonephritis. Less than permanent a sign of renal tuberculosis is microhematuria, It occurs in about 1/3 cases. Protein content in urine, usually, less than 1 g / l. Relative density of urine 1,005-1,012, and the reaction is usually acidic, but joining a secondary infection urine becomes alkaline (bacterially-ammonia fermentation).

Microscopic examination of urinary sediment revealed a large number of white blood cells, predominantly neutrophilic granulocytes. Often there gvozdevidnye leukocytes - elongated shape with a certain thickening at one end. They are quite specific to tuberculous pyelonephritis, although there is not in all cases of the disease.

Often, the urine appears small admixture of eosinophilic granulocytes. Red blood cells, often leached, are found in varying amounts (mikrogematuriâ). You can also identify cells transitional epithelium of the renal pelvis, part with steatosis. Diagnostic value of detection in urine has the elements of disintegration of tubercles (epithelioid, polynuclear giant cells and cheesy decay). They can be found in urine sediment and small pieces of the decay of tubercles.

The most important for the diagnosis of renal tuberculosis is detection of Mycobacterium tuberculosis in urine, which can reveal the presence of white blood cells. The only exception is closed pyonephrosis, wherein the detection of Mycobacterium tuberculosis presents certain difficulties. The question of the characteristic for tuberculosis "aseptic pyuria", in which Mycobacterium tuberculosis suppress all other microorganisms in urine, It is currently being revised. Almost half of the patients with tuberculosis of the kidneys in urine sown nonspecific bacterial flora.

Mycobacterium tuberculosis can be detected in urine bacterioscopic, bacteriological methods and by bioassay.

Smear method It involves microscopic examination of urine sediment, Ziehl-colored Nelsenu.

For bacteriological examination it is necessary to sow urine sediment on special nutrient media, particularly favorable for the growth of Mycobacterium tuberculosis. Most often made potato crop on Wednesday Lowenstein or seeding depth onto blood Wednesday Preis-Shkolnikova. When sowing the first method results are obtained through 1-1,5 months, and the second - in 1 2 week in the presence of M. tuberculosis and after 1 month in their absence.

The most sensitive method for detecting Mycobacterium tuberculosis is biological sample: inoculation of urine sediment (under the skin or in the peritoneal cavity) guinea pig, has a special penchant for tuberculosis. If a guinea pig is not killed within two months, its scoring. In either case, the animal autopsied and scrutinize. Identification of the guinea pig tuberculous lesions is a reliable confirmation of the diagnosis. With the help of bacteriological and biological samples detected Mycobacterium tuberculosis renal tuberculosis in 70 80 % cases.

In preparations, stained by Ziehl - Nelsenu, Mycobacterium tuberculosis detected among leukocytes, they are often phagocytosed by leukocytes. It should be remembered, in urine can be detected the acid- Alcohol and sticks, saprophytes, nothing in common with Mycobacterium tuberculosis do not have. They are thicker and coarser Mycobacterium tuberculosis.