Korean Journal of Nephrology 1989;8(2):271-278.

신부전을 동반한 신결핵이 임상적 고찰

이홍렬 , 강신욱 , 이혁우 , 김영기 , 이세준 , 최규현 , 이호영 , 한대석

Abstract

Renal tuberculosis, a genitourinary disease usually associated with pulmonary tuberculosis, shows a declin- ing incidence but still a disease often seen in this coun- try. As in most other forms of extrapulmonary tubercu- losis, renal tuberculosis originates by a blood-borne dissemination from a primary focus elsewhere in body, usually in lung. Ureter, urinary bladder, testis, and epididymis may also be infected secondarily from an infected kidney through the urine. Since the treatment with antituberculous drugs must continue for 18 -24months, the accurate diagnosis and the close obser- vation are important in management. Microscopic hematuria or pyuria may be the initial manifestation but with the progression of the disease, gross hematuria, hydronephrosis, secondary urinary tract infection, and renal failure may be complicated in some cases. Between 1st. January 1979 and 31th. December 1988, 186 patients were discharged from Severance Hospital with diagnosis of renal tuberculosis and among them, 23 patients had serum creatinine level above 2.0 mg/dl. We reviewed the clinical, laboratory, and the radiological findings of these patients and evaluated the treatment modality in these 23 patients with renal failure. The results are followings: 1) The age distribution was 18-69 year-old with mean of 38.8 years and the sex ratio was 1.3:l. 2) Seventeen patients(73.9%) complained of constitu- tional symptoms such as fever, night sweating, and weight loss, and the frequency of the subjective symp- toms was urologic symptoms(frequency, dysuria, noctur- ia)(69.6 %), flank pain or abdominal pain(60.9%), gross hematuria(43.5%), and nausea(26.1%) in order. On phys- ical examination abdominal tenderness was observed in 9 patients(39.1%), CVA tenderness in the same number, pitting edema in 4(17.4%), and hypertension in 4(17.4%) also. 3) Urinalysis revealed some abnormality in all patients except one, but positive urine AFB was obser- ved only in 7 patients(30.4%). Superimposed UTI was observed in 9 patients and caseating necrosis on biopsy was proven in 3. 4) Abnormal IVP was detected in 18(94.7%) of 19 patients. Pulmonary tuberculosis was accompanied in 16(69.6%) of 19 patients. Pulmonary tuberculosis was accompanied in 16(69.6%) with active lesion in 7(30.4%) and undetermined lesion in 2 patients(8.7%). 5) Causes of renal failure in renal tuberculosis were obstruction in 10 patients, UTI in 4 and dehydration in 4. 6)The most common pathogens of UTI in renal tuber- culosis were Pseudomonas(47.1%) in catheter inserted cases and E.coli(33.3%) was the most common organism in cases without catheter. 7) All patientw except one was treated with antituberculous drugs and surgical managements include- ing nephrostomy, nephrectomy ureterostomy and or- chiectomy were done in 12 patients(52.2%). 8) During the follow up period, 6 patients showed an improvement in renal function, 3(30%) worsened, and 1(10%) died of CVA complication. Based upon these results, renal failure in renal tuber- culosis can be treated with a hope for an improvement in renal function, and most of all continuous chemother- ay and persistent follow up are important.