A case of renal tuberculosis diagnosed during percutaneous nephrolithotomy

Hakan Öztürk, Musa Saraçoglu, Serap Karaarslan, Tarik Zengin, Aşkın Gülşen, Sena Kalaycıoğlu

Chest Diseases Department, Sifa University, Izmir, Turkey;.
Pathology Department, Sifa University, Izmir, Turkey.
Radiology Department, Sifa University, Izmir, Turkey.
Urology Department, Sifa University, Izmir, Turkey.
Urology Department, Sifa University, Izmir, Turkey;.

DOI: 10.4236/crcm.2013.27109                

Abstract

Percutaneous nephrolithotomy (PCNL) is very popular and an efficient method as a gold standard in management of renal calculi. It is the first-choice method in management of renal calculi larger than 2 cm. Our patient underwent PCNL upon observing multiple renal calculi larger than 10 mm in a lower pole of the right kidney. Biopsy was performed during PNCL because morphology and endoscopic view of the calyx were irregular, calcific and pale white in color. The patient developed prolonged urinary leakage from the lumbar region and J-stent was inserted after the re-entry catheter had been removed following successful PCNL. Prolonged urinary leakage persisted although location of the J-stent was normal. Tuberculosis of the urinary tract should be the first option in the dif ferential diagnosis of fistula discharge following PCNL. In our patient, the biopsy taken at the time of PCNL revealed renal tuberculosis. Urinary tract tuberculosis must definitely be considered in the fistula tract persisted and not closed fol lowing PCNL as in the present case. Diagnosis of tuberculosis was made early in this case owing to tissue sampling during operation, and thus the treatment was begun early. So we consider this patient as a special case.

Keywords

Renal Tuberculosis; PCNL

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	World Health Organization (2009) Global tuberculosis control: Surveillance, planning, financing. WHO report 2009. World Health Organization, Geneva.
[2]	Morrison, J., Pai, M. and Hopewell, C.P. (2008) Tuberculosis and latent tuberculosis infection in close contacts of people with pulmonary tuberculosis in low-income and middle-income countries: A systematic review and metaanalysis. The Lancet Infectious Diseases, 8, 359-368. http://dx.doi.org/10.1016/S1473-3099(08)70071-9
[3]	Stead, W.W. (1981) Tuberculosis among elderly persons: An outbreak in a nursing home. Annals of Internal Medicine, 94, 606-610. http://dx.doi.org/10.7326/0003-4819-94-5-606
[4]	den Boon, S., van Lill, S.W., Borgdorff, M.W., et al. (2005) Association between smoking and tuberculosis infection: A population survey in a high tuberculosis incidence area. Thorax, 60, 555-557. http://dx.doi.org/10.1136/thx.2004.030924
[5]	Rieder, H.L. (1999) Epidemiologic basis of tuberculosis. International Union Against Tuberculosis and Lung Disease, Paris.
[6]	Bates, M.N., Khalakdina, A., Pai, M., et al. (2007) Risk of tuberculosis from exposure to tobacco smoke. A systematic review and meta-analysis. Archives of Internal Medicine, 167, 335-342. http://dx.doi.org/10.1001/archinte.167.4.335
[7]	Guelar, A., Gatel, J.M., Verdejo, J., et al. (1993) A prospective study of the risk of tuberculosis among HIVinfected patients. AIDS, 7, 1345-1349. http://dx.doi.org/10.1097/00002030-199310000-00007
[8]	Barrera, L. (2007) The basics of clinical bacteriology. In: Palomino, J.C., Leao, S.C. and Ritacco, V., Eds., Tuberculosis 2007: From Basic Science to Patient Care, Sao Paulo, 93-112. www.TuberculosisTextbook.com
[9]	Niederweis, M. (2003) Mycobacterial porins: New channel proteins in unique outer membranes. Molecular Microbiology, 49, 1167-1177. http://dx.doi.org/10.1046/j.1365-2958.2003.03662.x
[10]	Goletti, D., Stefania, C., Butera, O., et al. (2008) Accuracy of immunodiagnostic tests for active tuberculosis using single and combined results: A multicenter TBNETstudy. PLOS Medicine, 3, Article ID: e3417.
[11]	Iseman, M.D. (2000) A clinician’s guide to tuberculosis. Lippincot, Williams, Philadelphia.
[12]	Hopewell, P.C. (2005) Tuberculosis and other mycobacterial diseases. In: Mason, R.J., Murray, J.F., Broaddus, V.C. and Nadel, J.A., Eds., Murray and Nadel’s Textbook of Respiratory Medicine, 4th Edition, Elsevier Saunders, Philadelphia, 979-1043.
[13]	Golden, M.P. and Vikram, H.R. (2005) Extrapulmonary tuberculosis: An overview. American Family Physician, 72, 1761-1768.
[14]	Gow, J.G. (1999) Genitourinary tuberculosis In: Schlossberg, D., Ed., Tuberculosis and Nontuberculous Mycobacterial Infections, 4th Edition, Saunders, Philadelphia, 195-203.
[15]	Bentz, R.R., Dimcheff, D.G., Nemeroff, M.J., et al. (1975) The incidence of urine cultures positive for M. Tuberculosis in a general tuberculosis patient population. American Review of Respiratory Disease, 111, 647-650.
[16]	American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America (2005) A controlling tuberculosis in the United States. American Journal of Respiratory and Critical Care Medicine, 172, 1169-1227. http://dx.doi.org/10.1164/rccm.2508001