Nasir Anwar, Azher A.
Tuberculosis in a solitary kidney.
Pak J Med Res Jan ;41(4):173-4.

A case report of acute renal insufficiency due to non-obstructive tuberculous involvement of a solitary kidney in a middle aged lady with restoration of normal renal function upon successful completion of treatment is presented. Possible mechanisms of renal dysfunction are elucidated.

Case Report: A 40 years old Afghan lady was admitted with short history of persistent dull right flank discomfort and macroscopic haematuria. She denied symptoms of urinary frequency, nocturia, urgency or dysuria. There was no history of weight loss, night sweats, fever, cough or breathlessness. Past medical history included episodes of UTI. On examination, she was apyrexial with no pallor or palpable lymph gland enlargement. She was euvolemic and normotensive with no postural drop. No abnormality was detected on systemic examination. Urinalysis revealed albumin +, numerous RBCs and pus cells 5 - 6. 24 hours urinary volume (1400m1) revealed 1.0 gram of protein. Special stains for AFB on early morning concentrated urine sediment were negative and no Mycobacterium tuberculous was isolated from the urine on culture. She had impaired renal function with serum creatinine of 3mg% and blood urea of 60mg%. Her haemoglobin was 10.6 gm% with an ESR of 20mm 1st/hr and normal blood counts. Anti-nuclear factor and rheumatoid factor were negative. X-ray chest was normal with no pulmonary lesions or hilar lymphadenopathy. Tuberculin test was negative. Abdominal ultrasound revealed a solitary right kidney measuring 14.3 curs x 5.8 curs in bipolar length with no evidence of obstruction. Left kidney was reported as absent. This was confirmed by DMSA scan. An ultrasound guided renal biopsy was obtained from lower pole of right kidney, which showed chronic granulomatous inflammation with focal necrosis histologically compatible with tuberculosis. The Immunoflorescence studies were unremarkable. A diagnosis of renal tuberculosis was made and she was put on anti-tuberculosis treatment. She was given Isonizazid (300mg/day), Rifampicin (450mg /day) and Pyrazinamide (1500 mg/day) along with Pyridoxine. Pyrazinamide was withdrawn after 2 months. Six months of therapy progressively reduced the values of plasma creatinine and urea levels to 1.2 mg% and 40mg% respectively with normal urinalysis on repeat examinations. She completed a nine months course of anti-tuberculosis chemotherapy. A follow-up six months after the completion of therapy found her in good health with normal renal function.

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