Tuberculosis of the genitourinary system( nephrotuberculosis)

Tuberculosis of the genitourinary system is a specific inflammatory disease of the genitourinary organs, which is caused by the mycobacterium tuberculosis. The kidneys are most often affected in this disease, although the localization of the infectious process in the bladder or ureters is possible.

Causes of tuberculosis of the genitourinary organs

The causative agent of tuberculosis is mycobacterium, which was first discovered by Robert Koch back in 1882.To date, there are already more than seventy different types of mycobacterium tuberculosis, although the organs of the genitourinary system affect only bovine and human strains.

As is known, practically the entire population of the globe is the bearer of this causative agent, and only a small part of humanity suffers from the disease. First of all, it depends on the number of bacteria in the human body and the state of the immune system, which does not allow these bacteria to multiply. Most susceptible to the risk of contracting tuberculosis of the genitourinary system are those who have a history of chronic inflammatory diseases of these organs and are in constant contact with patients with tuberculosis.

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Tuberculosis of the genitourinary system can occur with direct penetration of the pathogen or when entering it from another diseased organ, most often the lungs. In most cases, this happens with the blood flow. This variant of tuberculosis of the genitourinary system is called secondary.

Symptoms of tuberculosis of the genitourinary system

Symptoms of this disease, largely depend on which organ of the genitourinary system is affected. For example, with kidney tuberculosis, there are both local and general symptoms. Patients complain of worsening general condition, fatigue, increased sweating, sleep disturbance and dyspnea. They are also concerned about dull pain in the lumbar region, which develop due to the extension of the capsule of the kidney. Together with this there is a violation of urination in the form of its delay or vice versa. Patients may also note pain or discomfort during urination.

When the bladder is affected by the bladder, the main symptom is the increased frequency of urination. In addition, due to ulceration of the mucous membrane of the bladder, there may be soreness at the end of the act of urination and the allocation of a small amount of blood in the urine.
Another symptom that arises due to kidney failure is tuberculosis, it is an increase in blood pressure. It has the same character as in other kidney pathologies - due to increased renin release, the spasm of the arteries develops, which leads to an increase in blood pressure.

If a patient has such symptoms, he should go to a consultation with the urologist to confirm the urological pathology or send the patient to a consultation with the TB doctor.

Kidney for tuberculosis

Diagnosis of tuberculosis of the genitourinary system

During general clinical studies in the analysis of urine, it is possible to detect a large number of leukocytes, a high content of erythrocytes and protein, as well as a high titer of bacteria. After conducting a bacterioscopic examination of the patient's urine, in most cases, it is possible to detect the presence of mycobacteria tuberculosis, which have the form of red sticks on a blue background.

Microscopic examination is good because it gives operational results. Its only drawback is that with a small number of bacteria in the urine, they can not be seen under a microscope. In such a situation, a bacteriological method is used, during which the urine of the patient is sown on the nutrient medium of Stein-Leventhal, where in two weeks colonies of microorganisms are formed. This method gives a 100% result even with a small bacterial number. The only downside is that 14 days are required to confirm the diagnosis.

As nephrotuberculosis often becomes a complication of the pulmonary form of the disease, it is necessary for patients to perform a chest X-ray. With a positive result, obscuration fields are noted on the X-ray, which are the direct signs of tuberculosis.

In addition to confirming the diagnosis, the patient must determine the anatomical and functional state of the kidneys. This can be done with the help of ultrasound examination of the organs of the retroperitoneal space and excretory urography. The results of these methods completely depend on the stage of the disease. If at the initial stages there can be no changes at all, then in later stages there are both structural changes and violations of urinary excretion by one or two kidneys.

Excretory urography for tuberculosis of the kidneys

Many parents refuse to conduct a chest X-ray examination of their children, motivating it with a high dose of ionizing radiation. In such a situation, the child is given a classical tuberculin test of Mantoux. The result of the test is considered positive if the papule that appeared on the third day after the injection exceeds ten millimeters in diameter. In turn, a sample of up to 3 mm is considered negative, and in the border from 3 to 10 - a questionable, subject to repeated conduct.

There are other methods for diagnosing the tuberculosis process of the genitourinary system, such as ascending cystography, radioisotope renography, retrograde pyelography, and CT and MRI.But they, because of their impracticality and high cost, have not found wide application in the diagnosis of the tuberculosis process of the genitourinary system.

Treatment of nephrotuberculosis

Depending on the clinical course and the morphological state of the kidneys, nephrotuberculosis is divided into four stages. For the first two, conservative therapy is used, and for the other two, surgical treatment is used. As a conservative therapy, a classical combination of chemotherapeutic and antibacterial drugs is used: isoniazid, ethambutol, rifampicin and streptomycin. All these drugs are applied once a day in the morning under the supervision of medical personnel for 6-9 months. These drugs are purchased under the state program and are delivered directly to anti-tuberculosis treatment facilities.

Because patients with nephrotuberculosis for a long time are on powerful antibacterial treatment, they need the use of symptomatic drugs to improve the functional state of the liver and intestines. To this end, they are assigned such hepatoprotectors as Carlos and probiotics such as Lacium. Unfortunately, with these medicines are not included in the state program for the treatment of tuberculosis, and their patients are forced to buy independently.

Operative treatment of tuberculosis of the genitourinary system is radical. For example, in the third or fourth stage of nephrotuberculosis, patients need to remove the entire kidney. However, in tuberculosis surgery there is a rule according to which the scalpel should not spread the mycobacterium in the wound. That is why, the operation is carried out in the "cold" period of the disease, after a year of antibiotic therapy.

Features of Nutrition and Lifestyle

Tuberculosis patients are usually asthenic. They need nutrition with high calorie foods. True, with nephrotuberculosis, from the difference from this disease of other localizations, it is necessary to take into account the functional state of the kidney. Therefore, all fried, smoked, sour and salty dishes are excluded from the diet. Patients are not allowed to drink alcoholic beverages, strong coffee and tea.

The diet of such patients should consist of high-calorie boiled meat, white bread, potatoes, various cereals and sweets. As a drink, cranberry juice is prescribed, which has a very good effect on kidney function.

Rehabilitation after illness

Because tuberculosis, irrespective of its location, is an incurable disease, patients need lifelong rehabilitation. For this purpose, even year-round sanatoriums have been built near the sea coasts, where special conditions have been created for the treatment and prevention of various forms of tuberculosis infection.

In the absence of the opportunity to visit such resorts, patients are recommended periodic courses of physiotherapy treatment. For this purpose, special thermal irradiation of the lumbar region is used to create conditions unfavorable for the life and reproduction of the mycobacterium.

As already mentioned, patients with tuberculosis of the genitourinary system undergo long courses of antibacterial and chemotherapeutic treatment, as a result of which the normal microflora of the gastrointestinal tract suffers. To restore it, you can take the previously mentioned drugs or eat foods containing fermented bacteria( kefir, fermented baked milk, ferment).

Complications of the tuberculosis of the genitourinary system

The Saami is a formidable complication of this disease is the development of chronic renal failure, which soon needs constant support from the hemodialysis apparatus. To prevent this from happening, it is necessary to start medical treatment in a timely manner.

Another complication, which, unlike the first, develops as a result of a positive outcome of treatment, is scarring of the kidney. It simply leads to a decrease in the functional capacity of the organ and increased stress on the second kidney. Also, with this complication, sclerosis of the renal artery may occur, which is accompanied by an increase in blood pressure.

In addition, renal tuberculosis is a good basis for attaching secondary infection or the formation of stones in the lumen of the renal pelvis.

Prevention of tuberculosis of the genitourinary system

To protect yourself from the development of the tuberculosis process, you must avoid contact with infectious patients. If you can not get rid of this, for example, due to professional factors, then you need to use personal protective equipment, for example, gauze masks.

The second direction in the prevention of tuberculosis infection is the maintenance of a normal lifestyle, the lack of smoking and alcohol abuse. Of no small importance in the prevention of tuberculosis is normal nutrition and satisfactory material and living conditions.

Rev.doctor urologist Astashin Е.Е.