How to identify and correctly treat cavernous tuberculosis of the kidneys

  • How to identify and correctly treat cavernous tuberculosis of the kidneys

    Among all extrapulmonary tuberculosis lesions, tuberculosis of the kidneys should be considered the most common form of the disease. Initially, with the development of tuberculosis of the kidneys, damage to the cortical layer is formed. The subsequent progression of pathology is complemented by the process of tissue disintegration, the formation of caverns and cavities in the kidney parenchyma, and impaired renal function. In especially severe cases, there is a purulent fusion in the tissues of the kidney and involvement in the infection of the ureter, pelvis, genitals and bladder.

    In urology, the classification of renal tuberculosis was adopted, taking into account the clinical and radiological features of the pathology. According to it, the disease is divided into the following forms:

    • Tuberculosis of the kidney parenchyma, which is supplemented by the appearance of a large number of foci in the medullary and cortical part of the organ.
    • Tuberculous papillitis - causes damage to the renal papillae.
    • Cavernous tuberculosis of the kidneys - causes the union of lesions with encapsulation.
    • Fibrous-cavernous tuberculosis - causes obliteration of the calyces, followed by the formation of purulent cavities there.
    • Calcification of the kidney - manifested by the formation of pathological foci with clear boundaries with the content of a large number of calcium salts.

    Etiology of the disease

    The causative agent of renal tuberculosis is the microbacterium of tuberculosis, usually this pathology develops in people with pulmonary or osseous tuberculosis, five to ten years after the course of the primary form.

    Infection enters the kidney by hematogenous way - through the blood. Together with the blood flow, microbacteria penetrate into the glomerular apparatus and form a large number of tubercular foci there. With good local and general immunity of a person and with a small size of primary foci, they lend themselves to a complete reverse development.

    If hemodynamics or urodynamics are disturbed, if the immunity works from the cortical part, the infection gets into the brain substance, provoking an inflammatory process in the kidney papillae. In the future, the disease affects the entire thickness of the kidney pyramids, forming a caseous tissue decomposition, which is complemented by the formation of caverns. The active development of pathology leads to the formation of cavities in the kidney and pionephrosis.

    Manifestations of the disease

    Clinical signs of renal tuberculosis do not cause pathognomonic symptoms. At the first stages of the development of the disease, it can be latent or characterized by a violation of the general state of health - malaise, fatigue, low temperature and progressive course.

    The destructive abnormalities of the kidney work are supplemented by painless total hematuria, provoked by erosive processes in the vessels during the formation of ulcers on the renal papillae. Bleeding often turns into pyuria, which indicates the onset of the process of pyelonephritis or pyelitis.

    Treatment of the disease

    Treatment of renal tuberculosis can be combined or drug therapy. Medicinal treatment consists in taking specific antituberculous medicines for 6 to 12 months.

    Conducting specific chemotherapy is supplemented by the intake of NVPs, angioprotectors, which will help prevent the formation of shrinkage of the kidney tissue. It is important to remember that prolonged therapy with antituberculous drugs can provoke severe dysbiosis, hypersensitivity reactions. Due to the violation of urinary retention from the kidney, a special stent or nephrostomy organization is necessary. With local destruction in the kidney conservative treatment is carried out by sanation of the lesion.

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