Renal Tuberculosis

Fifty-five year old patient complaining about hematuria, dysuria and

left flank pain. No history of tuberculosis, just an uncontrolled diabetes,

smoked one pack of cigarettes per day for the last ten years. Laboratory

results: glucose 130 mg/dL, creatinine 1.1 mg/dL, white blood cells 7500/μL,

hemoglobin 12.1 g/dL, hematocrit 37%; urine analysis: 28 leukocytes, nine

erythrocytes per field. No bacteria grown in urinary culture. Normal chest

radiography. On intravenous pyelography both kidneys were simultaneously

functional, discontinuity between the left ureter and pelvis, calyceal dilatation

in the left kidney and multiple renal calculi. The patient undertaked

percutaneous nephrolithotomy

and because morphology and

endoscopic view of the renal

calyx was asymmetrical, biopsy

was performed. A histopathologically

positive result was

identified by a granulomatous

reaction, which included Langerhans

cells and caseification

necrosis. Negative for infection

with human immunodeficiency

virus. Started orally antituberculous

therapy based on actual

body weight1 with Isoniazid,

Rifampin (Rifadin, Rimactane),

Ethambutol (Myambutol), Pyrazinamide

associated with Vitamin

B-6 (pyridoxine). His condition

improved over the course of

the next weeks.