Abstract:

Objective To summarize the clinical, imaging and pathological features of renal tuberculosis as manifestation of autonephrectomy in order to improve the clinical diagnosis level of autonephrectomy.Methods We analyzed the clinical features, pathological manifestations, laboratory results, imaging characteristics, treatment and prognosis in two cases of renal tuberculosis with autonephrectomy admitted in Infectious Disease Hospital of Heilongjiang Province on Nov. 11, 2017 and Dec. 4, 2017, respectively. Taking 2000-2018 as the retrieval time and “renal tuberculosis, autonephrectomy” as the key word, 10 articles including 12 cases were retrieved from PubMed, Wanfang database and China National Knowledge Infrastructure (CNKI). The general information, duration of disease, location of lesion, clinical manifestations, laboratory and imaging results, complications, diagnostic methods, treatment and prognosis were collected and made meta-analysis.Results There were frequent micturition, urgent micturition, odynuria and lumbago in two cases. The results of molecular biology of Mycobacterium tuberculosis including the gene chip assay for Mycobacterium tuberculosis resistance in urine and T-SPOT.TB test in blood were all positive. Renal CT showed volumetric reduction and complete calcification in the left renal. Intravenous pyelography showed no development of left renal pelvis, renal calyx and ureter. Clinical diagnosis was autonephrectomy. Two patients underwent left nephrectomy. The gross pathological features were grayish yellow cysts on the cut surface of renal tissue, gray-yellow gray-white necrotic foci in the capsule, and yellowish soybean dregs like greasy substance in the renal tissue. Chemotherapy containing pasiniazide or isoniazid, rifampicin, ethambutol, pyrazinamide was performed after operation for one year. After 6 and 9 months of discharge, the symptoms of frequent micturition, urgent micturition, odynuria disappeared. There were 14 cases data including 12 cases with autonephrectomy from literature screening and 2 cases from the report of this study. Of 14 cases, 9 cases were male and 5 cases were female, aged from 34 to 77 years old. There were bilateral renal tuberculosis in 3 cases and unilateral renal tuberculosis in 11 cases including 6 cases in left renal and 5 cases in right renal. The volume of diseased renal reduced and complicated with calcification in 12 cases, and the volume of diseased renal enlarged with circular cysts and thick-walled circular calcification in 2 cases. There were complicated with hypertension in 2 cases, seminal vesicle tuberculosis and bladder tuberculosis in 1 case, epididymis tuberculosis in 2 cases, retroperitoneal lymph node tuberculosis in 1 case, right spontaneous renal fistula in 1 case, and contralateral ureteral calculi complicated with acute renal failure in 3 cases. Nephrectomy of diseased renal underwent in 6 cases, and chemotherapy was performed in 5 cases, and treatment was done with unknown regimen in 3 cases. The symptoms of frequent micturition, urgent micturition, odynuria disappeared in all cases after treatment.Conclusion The clinical symptoms are more serious with more complications in renal tuberculosis with nephrectomy. Imaging examination is an important means of diagnosis. Nephrectomy of diseased renal is one of the important methods of treatment.

Key words: Tuberculosis, renal, Ultrasonography, Tomography, X-ray computed, Pathological conditions, signs and symptoms, Review literature as topic, Consensus development conferences as topic