Renal Tuberculosis

Renal Tuberculosis - Renal Tuberculosis Epidemiology...

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Renal Tuberculosis
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Epidemiology
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Globally, tuberculosis is a common disease, with 8 to 10 million new cases annually and a rising incidence, particularly in regions with a high incidence of HIV infection Genitourinary disease is a common form of nonpulmonary tuberculosis
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By far the most common causative organism is the human tubercle bacillus, M. tuberculosis, but the bovine tubercle bacillus, M. bovis, occasionally can be responsible Other species within the genus Mycobacterium are free-living environmental saprophytes and are commonly found in water, including piped water supplies
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Some of these environmental mycobacteria occasionally cause human disease, particularly in immunosuppressed individuals, including recipients of renal transplants Because they occur in water, environmental mycobacteria readily contaminate the lower urethra and external genitalia and, thus, often are isolated from urine samples
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The kidney usually is infected by hematogenous spread of bacilli from a focus of infection in the lung In most cases, at the time of presentation there is no evidence of active pulmonary disease suggesting that renal involvement occurs as a result of reactivation after a period of dormancy
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If a tuberculous lesion in the lung gains access to the vascular system by erosion of the wall of a vessel, usually a vein, then emboli containing organisms may be disseminated throughout the body However, the bacilli have stringent growth requirements and generally tend to proliferate only in a small number of sites, including the kidney, epididymis, fallopian tube, bone marrow, and brain, particularly the hindbrain
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Clinical features
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Many patients present with lower urinary symptoms typical of conventional bacterial cystitis Other symptoms that sometimes occur include back, flank, and suprapubic pain, frequency, and nocturia
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Persistent hematuria and pyuria should mandate evaluation of the genitourinary system that should include upper tract imaging, extensive microbiologic studies, cystoscopy, and tissue biopsy Renal colic is uncommon, occurring in fewer than 10% of patients, and constitutional symptoms such as fever, weight loss, and night sweats also are unusual
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A tuberculous kidney may become calcified and nonfunctioning If the gross anatomic distortion is advanced and bilateral, the GFR will fall and, in some patients, there is progression to end-stage renal failure
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Renal Tuberculosis - Renal Tuberculosis Epidemiology...

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