INTRODUCTION

Tuberculosis may lead to renal dysfunction via a range of mechanisms; these

include direct infection of the kidney and lower urinary tract, tubulointerstitial
nephritis, glomerulonephritis, secondary amyloidosis, and obstructive uropathy.
Associated adverse effects include mild hyponatremia due to the syndrome of
inappropriate antidiuretic hormone secretion (SIADH) induced by pulmonary
involvement, and nephrotoxicity induced by antimycobacterial agents.
TUBERCULOUS URINARY TRACT INFECTION
Genitourinary tuberculosis (TB) is a common form of extrapulmonary disease; an
estimated 4 to 20 percent of individuals with pulmonary infection develop
genitourinary involvement, mostly in developing countries [1,2]. Genitourinary
TB is more common in men than in women. Hematogenous seeding at the time of
primary pulmonary infection can lead to renal involvement; infection can also
occur in the setting of late reactivation disease or miliary disease. Of patients with
miliary disease, 25 to 62 percent have been documented to have concomitant renal
lesions [3]. (See "Clinical manifestations, diagnosis, and treatment of
extrapulmonary and miliary tuberculosis" and "Epidemiology and pathology of
extrapulmonary and miliary tuberculosis".)
Mycobacterial seeding leads to granuloma formation in proximity to glomeruli.
These may heal with fibrosis in the absence of overt renal disease. Alternatively,
the granulomas may caseate and rupture into the tubular lumen; this can occur up
to 30 years after the initial infection. Subsequently tuberculous bacilli can enter
the medullary interstitium, leading to granuloma formation and progressive
medullary injury [4,5]. Destruction of renal papilla can lead to calyceal ulceration
or abscess formation. Involvement of the collecting system may result in fibrotic
scarring and stenosis.
Clinical manifestations The onset of genitourinary TB is usually insidious,
presenting with malaise and lower urinary tract symptoms, including dysuria and
gross hematuria [4-6]. Renal colic is an uncommon manifestation. Systemic
symptoms (fever, weight loss) are relatively rare, since rupture of the glomerular
granulomas occurs independently of disease activity at other sites [4,7]. Some
patients are asymptomatic; in such cases, pyuria and/or microscopic hematuria
may be observed as incidental findings.
Pyuria and/or microscopic hematuria are present in more than 90 percent of cases
[4]. Heavy proteinuria and cellular casts are not generally seen, and the plasma
creatinine concentration is usually normal. Ureteral stricture can occur and may
cause obstructive uropathy [7,8]. TB can also cause chronic epididymitis or
prostatitis and should be considered in cases that fail to respond to antibacterial
therapy. Infertility can occur in the setting of tuberculous involvement of seminal
vesicles and ejaculatory ducts in men and fallopian tubes in women [1]. Late
presentation of genitourinary TB with end-stage renal disease can be irreversible
[9].