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. 2023 Oct 13:33:100402.
doi: 10.1016/j.jctube.2023.100402. eCollection 2023 Dec.

Ureteral obstruction may activate kidney latent tuberculosis. A qualitative study

André Avarese Figueiredo  1   2 , Augusto de Azevedo Barreto  1 , Humberto Elias Lopes  1   2 , José Murillo Bastos Netto  1   2
Affiliations

Ureteral obstruction may activate kidney latent tuberculosis. A qualitative study

André Avarese Figueiredo et al. J Clin Tuberc Other Mycobact Dis. .

Abstract

Objectives: To analyze the hypothesis that ureteral obstruction may activate kidney latent tuberculous though qualitative study of Urogenital Tuberculosis patients.

Methods: A qualitative study was conducted using semistructured interviews in eight patients with Urogenital Tuberculosis. The progression of the disease from the initial symptoms was characterized through the analysis of the clinical and radiological data. The presence of ureteral obstruction prior to the onset of renal tuberculosis was observed in three patients.

Results: Patient 1: A 58-year-old female had five episodes of acute left ureteral lithiasis in two years prior to left kidney tuberculosis. Patient 2: A 55-year-old male patient had a 1.2 cm proximal left ureteral stone and in the following six months, the diagnosis of tuberculosis was made in a nonfunctioning left kidney with ureteral thickening and stenosis. Patient 3: A 47-year-old male patient had a 1.2 cm stone in the proximal right ureter and developed urinary tuberculosis with a nonfunctioning right kidney and a contracted bladder.

Conclusion: Kidney tuberculosis may appear in the same kidney that had previously suffered stone ureteral obstruction, which may have created local conditions for the activation of latent foci of renal tuberculosis.

Keywords: Kidney tuberculosis; Tuberculosis; Tuberculosis reactivation; Urinary lithiasis; Urogenital tuberculosis.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1a
Fig. 1a
Abdominal tomography with normal right kidney, normal bladder but diffuse calicial dilatation with parenchyma atrophy in a nonfunctioning left kidney. There was previous history of five episodes of spontaneous elimination of left urinary lithiasis.
Fig. 1b
Fig. 1b
Cystography showing contracted bladder with right ureteral reflux, five years after left nephrectomy.
Fig. 2a
Fig. 2a
Time 1 – abdominal tomography showing a 1.2 cm ureteral stone in proximal ureter with urinary tract obstruction and a normal bladder.
Fig. 2b
Fig. 2b
Time 2 - abdominal tomography showing left urinary tract dilatation with ureteral thickening and areas of stenosis with parenchyma atrophy of the left kidney and a bladder with diffuse thickening and decreased capacity.
Fig. 3a
Fig. 3a
Time 1- abdominal tomography showing a 1.2 cm ureteral stone in proximal right ureter.
Fig. 3b
Fig. 3b
Time 1- abdominal tomography showing right kidney dilatation with normal kidney parenchyma.
Fig. 3c
Fig. 3c
Time 1 - abdominal tomography showing normal bladder.
Fig. 3d
Fig. 3d
Time 2- ultrasonography showing bilateral urinary tract dilatation but two different patterns. The right kidney (left in the image) presents diffuse calicial dilatation, parenchyma atrophy and nondilated renal pelvis (typical of renal tuberculosis). The left kidney presents pyelocaliceal dilatation with normal parenchyma (due to ureteral reflux).
Fig. 3e
Fig. 3e
Time 2- abdominal tomography showing right kidney with diffuse calicial dilatation and parenchyma atrophy and left kidney with pyelocaliceal dilatation with normal parenchyma (due to ureteral reflux).
Fig. 3f
Fig. 3f
Time 2- abdominal tomography showing contracted bladder with diffuse thickening and continuity with left ureter due to reflux.
Fig. 3g
Fig. 3g
Time 2- cystography showing contracted bladder with left ureteral reflux.
Fig. 4a
Fig. 4a
HE 40x. Nonactive granuloma in the renal cortex.
Fig. 4b
Fig. 4b
HE 40x. Medullary granuloma with caseous necrosis, ulceration, and erosion of the renal papillae to the excretory system.
See this image and copyright information in PMC

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