Tuberculosis of the genitourinary system ( nephrotuberculosis ) - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Urinary Systems.

Tuberculosis of the genitourinary system - this particular inflammatory disease of the urinary organs, which is caused by Mycobacterium tuberculosis.The most common in this disease affects the kidneys, although the possible localization of infection in the bladder or ureters.

Causes Tuberculosis urogenital organs

causative agent of tuberculosis is Mycobacterium, which was first identified by Robert Koch in 1882.Today has been known for more than seventy different species of Mycobacterium tuberculosis, though the organs of the urogenital system affects only bovine and human strains.

It is known that practically all the world's population are carriers of this pathogen, a disease suffered only a small part of humanity.First, it depends on the number of bacteria in humans and the immune system, which makes it impossible to reproduce these bacteria.Most at risk of urogenital system tuberculosis infection in those patients who have a history of chronic inflammatory diseases of the data and is constantly i

n contact with TB patients.

Tuberculosis urogenital system can occur by direct penetration of the pathogen or when entering it from another patient's body, usually in the lungs.In most cases this is with the blood flow.This option genitourinary tuberculosis is called secondary.

Symptoms of tuberculosis

genitourinary system symptoms of the disease, to a greater extent depend on which body the genitourinary system struck.For example, there are both local and general symptoms of tuberculosis kidney.Patients complain of deterioration of general condition, fatigue, sweating, insomnia and shortness of breath.They are also concerned about the dull pain in the lumbar region, which develop due to stretching of the kidney capsule.At the same time there is also a violation of urination as its more frequent delays, or vice versa.Also, patients may report pain or discomfort during urination.

With the defeat of tubercular process bladder main symptom is frequent urination acts.In addition, due to mucosal ulceration bladder may experience tenderness in the end of the act of urination and isolating small amounts of blood in urine.
Another symptom that arises due to the destruction of kidney tuberculosis is high blood pressure.It has the same character as in the other kidney pathologies - due to the increased release of renin, develops spasm of arteries, which leads to increased blood pressure.

If the patient has observed similar symptoms, he has to go to a consultation with a urologist, who confirmed that the urologic pathology or send the patient to consult a TB specialist.

bud in tuberculosis

Diagnosis of Tuberculosis of the genitourinary system

During the general clinical research in the analysis of urine is possible to identify a large number of white blood cells, red blood cells and an increased content of the protein, as well as a high titer of bacteria.After conducting microscopy studies of patient urine, in most cases, one can detect the presence of Mycobacterium tuberculosis, which have the appearance of red chopsticks on a blue background.

Microscopic examination is good because it gives rapid results.Its only drawback is that when small amounts of bacteria in urine, they can not be seen under a microscope.In such a situation, a bacteriological method in which the urine of the patient were seeded on a nutrient medium Stein-Leventhal where microbial colonies formed after two weeks.This method gives a perfect result even with a small number of bacterial.The downside is a technique that, for confirmation of the diagnosis is necessary to wait 14 days.

Since nephrotuberculosis often a complication of pulmonary form of the disease, the patient necessarily need to conduct X-ray examination of the chest.With a positive result, the X-rays observed darkening field, which are the immediate signs of tuberculosis.

Also confirm the diagnosis, the patient must determine the anatomic and functional state of the kidneys.This can be done using ultrasound retroperitoneal organs and excretory urography.The results of these methods are totally dependent on the stage of the disease.If in the initial stages could be no change at all, in late stages marked as structural changes and disorders of urine release one or two buds.

excretory urography in tuberculosis kidney

Many parents refuse their children of X-ray examination of the chest, citing the high dose of ionizing radiation.In this situation, the child is held classical tuberculin Mantoux test.The result of the sample is considered positive if the papule, which arose on the third day after injection, more than ten millimeters in diameter.In turn, the sample up to 3 mm is considered to be negative, but the border between 3 and 10 - doubtful, to be re-conduct.

There are other methods of diagnosis of tuberculous process of the urogenital system, such as the ascending cystography, radioisotope renografii, retrograde pyelography, and CT and MRI.But they, because of their impracticality and high cost, are not widely used in the diagnosis of tuberculous process of the genitourinary system.

Treatment nephrotuberculosis

Depending on the clinical course and morphological kidney condition nephrotuberculosis divided into four stages.In the first two apply conservative therapy, while the other two - operative treatment.As conservative therapy uses the classic combination of chemotherapeutic and antimicrobial drugs: isoniazid, ethambutol, rifampicin and streptomycin.All these drugs are used 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 the TB hospitals.

Since patients with nephrotuberculosis long time are a powerful antibacterial treatment, they need to apply symptomatic drugs to improve the functional state of the liver and intestines.For this purpose, they are assigned gepatoprotektory such as Kars and probiotics such as Latium.Unfortunately, these drugs are not included in the state program for the treatment of tuberculosis, and patients are forced to buy their own.

Surgical treatment of genitourinary tuberculosis is radical.For example, in the third or fourth stage nephrotuberculosis patients require removal of the entire kidney.However, in tuberculous surgery there is a rule according to which the scalpel should not spread over the wound mycobacteria.For this reason, the operation is carried out in a "cold" period of the disease, after a year-long course of antibiotic therapy.

Feeding habits and lifestyle

TB patients, as a rule, adynamic.They need food increased caloric.True, nephrotuberculosis, by contrast to the disease at other sites, it is necessary to take into account the functional state of the kidneys.Therefore, from the diet excludes all fried, smoked, sour and savory.Patients are prohibited from drinking alcohol, strong coffee, and tea.

diet of such patients should consist of high-calorie boiled meat, white bread, potatoes, various cereals and sweets.As drinking appointed cranberry juice, which has a very good effect on renal function.

rehabilitation after illness

Since tuberculosis, regardless of its location, is an incurable disease, patients require lifelong rehabilitation.To this end, at the sea coasts are built even year-round resorts where established special conditions for the treatment and prevention of various forms of tuberculosis infection.

In the absence of the opportunity to attend such spas sick periodic courses of physical therapy.For this purpose, use the special thermal exposure of the lumbar region to create conditions unfavorable for life and reproduction of mycobacteria.

As mentioned, patients with tuberculosis of the genitourinary system are longer courses of antibacterial and chemotherapeutic treatment, which is suffering as a result of the normal flora of the gastrointestinal tract.To restore it, you can take the previously mentioned drugs or eat foods that contain lactic acid bacteria (kefir, fermented baked milk, sourdough).

Complications of genitourinary tuberculosis

Sami threatening complication of the disease is the development of chronic kidney failure, which requires the constant support of the hemodialysis machine in a short time.To this did not happen, you need to start timely treatment measures.

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

addition, tuberculosis kidney is a good basis for the connection of a secondary infection or stone formation in the lumen of the renal pelvis.

Prevention of Tuberculosis of the genitourinary system

To protect yourself against the development of tuberculosis process, it is necessary to avoid contact with infectious patients.If it is impossible to get rid of, for example, due to occupational factors, it is necessary to use personal protective equipment, such as gauze masks.

second direction in the prevention of tuberculosis infection is to maintain a normal lifestyle, no smoking and alcohol abuse.Equally important in the prevention of tuberculosis has a normal and satisfactory food material and living conditions.

Ed.urologist Astashin EE