Repeated Dysuria, Hematuria With Low Back Pain, The Chance Of Misdiagnosis Of Kidney Disease Is High!

Kidney tuberculosis is a chronic, progressive kidney disease caused by Mycobacterium tuberculosis infection. There are usually no obvious symptoms and imaging changes in the early stage. As the disease progresses, typical clinical manifestations such as frequent urination, urgency, dysuria, hematuria, pyuria, low back pain, and lumps may appear.

Diagnostic criteria for Kidney tuberculosis

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As long as any one of the following three items is met, Kidney tuberculosis can be diagnosed.

First: Unexplained bladder irritation, positive urinary Mycobacterium tuberculosis culture;
Second: imaging evidence of urinary system tuberculosis;
Third: Cystoscopy shows typical tuberculous cystitis manifestations or pathological biopsy reveals tuberculous nodules or granuloma formation.

Treatment and Principles

In the follow-up treatment, due to the absence of a single kidney in the patient, to avoid severe Kidney damage in the later stage of the patient, early diagnosis and anti-tuberculosis treatment should be given. After obtaining the consent of the patient, combined anti-tuberculosis treatments such as isoniazid, rifampicin, and ethambutol, and liver protection treatment with diammonium glycyrrhizinate were given.

After taking anti-tuberculosis drugs, the patient complained of dysuria, hematuria, pyuria, and low back pain after urinating, and the reexamination of abdominal CT showed that the left kidney was smaller than before, and the lesions in the kidney were better than before.

For repeated low back pain with hematuria, you need to consider these 3 reasons!

1 Chronic pyelonephritis

Manifested as urinary frequency, urgency, dysuria, and other bladder irritation symptoms, accompanied by hematuria and low back pain. However, the symptoms are mostly intermittent, without persistent low-grade fever, and the pathogenic bacteria can be found in the common bacterial cultures of urine. The erythrocyte sedimentation rate (erythrocyte sedimentation rate) was generally normal, the tuberculin test was negative, and there were no acid-fast bacilli in the urine.

2 Kidney tumors

Can be manifested as low back pain, hematuria, and waist, and abdomen mass. However, bladder irritation symptoms such as frequent urination, urgency, and painful urination are not obvious. B-ultrasound examination, X-ray examination, and CT examination can find space-occupying lesions in the kidney.

3 Pyonephrosis

Chronic course pyonephrosis also presents with recurrent low back pain, often accompanied by night sweats, anemia, and weight loss. There were numerous pus cells in the urine, common bacterial cultures were positive, no acid-fast bacilli were present in the urine, and a CT Kidney scan revealed a mixed-density mass with indistinct borders in the Kidney parenchyma.

Kidney tuberculosis is relatively unfamiliar to doctors in primary medical institutions, and it is difficult to diagnose. In daily diagnosis and treatment activities, patients with frequent urination, urgency, dysuria with hematuria, pyuria, and low back pain may be encountered at any time. If the patient is older, urinary tract infections can be considered, such as acute cystitis, acute prostatitis, and the above diseases. After antibiotic treatment, the symptoms can disappear.

However, if the patient continues to have frequent urination, urgency, dysuria accompanied by hematuria, pyuria, and low back pain, the effect of antibiotic treatment is not satisfactory, and it is necessary to identify the causes in many ways and be alert to Kidney tuberculosis. If an abnormal lung image is found and the Kidney imaging is supportive, it is recommended to go to a designated tuberculosis medical institution for further diagnosis to avoid delaying the condition. Serious complications such as uremia and Kidney failure may occur in the late stage, which is life-threatening.

Kidney tuberculosis is almost always secondary to pulmonary tuberculosis infection, and occasionally secondary to bone and joint, lymphatic, and intestinal tuberculosis. If clinical Kidney tuberculosis is not treated, less than 30% of patients survive 5 years and less than 10% survive 10 years from the onset of clinical symptoms. If early diagnosis and timely and adequate modern anti-tuberculosis treatment can be obtained, Kidney tuberculosis should be cured, and most may not require surgery.

for more information:ali.ma@wecistanche.com