Kidney non-tumor - Tuberculosis

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Kidney non-tumor

Infections / parasites

Tuberculosis

Reviewer: Nikhil Sangle, M.D. (see Reviewers page)
Revised: 10 January 2013, last major update September 2012
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

General
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● Each year, 9 million new cases of TB, causing 1.5 million annual deaths (WHO: Global Tuberculosis Control 2011)
● GU tract is #2 most common site of infection after lungs

Clinical features
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● Renal involvement may be indolent, may not become apparent until 20+ years from detection of primary infection
● Urogenital TB is associated with unilateral non-functioning kidney in 27% of cases, with renal failure present in 7% (Int J Urol 2008;15:827)
● In chronic kidney disease of all causes, one study from India demonstrated a 4% incidence of TB, which was usually tuberculin skin test negative (Clin Nephrol 2007;67:217)
● In immunocompromised patients, urogenital TB usually has systemic symptoms, dissemination, multiple renal foci (Int Urol Nephrol 2009;41:327)

Case reports
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● 20 year old man (Am J Trop Med Hyg 2011;84:843)
● 29 year old man with renal hydronephrosis (Case of the Week #128)
● 33 year old man presenting with end stage renal disease secondary to renal TB (Rev Inst Med Trop Sao Paulo 2012;54:57
● 38 year old man with negative PPD and repeatedly negative AFB tests (Proc (Bayl Univ Med Cent) 2012;25:236)

Radiologic images
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Renal tuberculosis

Gross description
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● Multiple cavities filled with yellow friable necrotic material

Gross images
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Renal tuberculosis

Micro description
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● Extensive caseous necrosis, with occasional granulomas composed of epithelioid cells and Langhans giant cells with surrounding lymphocytes
● Very early granulomas might not show caseation
● The interface of viable cells and caseous necrosis is where acid-fast bacilli (AFB) are most found

Micro images
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Various images

Miliary tuberculosis - kidney

Differential diagnosis
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● Xanthogranulomatous pyelonephritis: different clinical picture, AFB negative, although AFB may be difficult to detect even in TB patients; TB PCR and AcuProbe are more sensitive (Int J Urol 2006;13:67)
● Occasionally fungal infections and sarcoidosis can cause non-caseating epithelioid cell granulomas

End of Kidney non-tumor > Infections / parasites > Tuberculosis

Ref Updated: 7/5/12

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