End-stage renal disease due to delayed diagnosis of renal tuberculosis: a fatal case report.

摘要: Renal TB is difficult to diagnose, because many patients present themselves with lower urinary symptoms which are typical of bacterial cystitis. We report a case young woman renal and ESRD. She was admitted complaints adynamia, anorexia, fever, weight loss, dysuria generalized edema for 10 months. At physical examination she febrile (39 degrees C), her abdomen had increased volume painful at palpation. Laboratorial tests showed serum urea = 220 mg/dL, creatinine 6.6 hemoglobin 7.9 g/dL, hematocrit 24.3%, leukocytes 33,600/mm(3) platelets 664,000/mm(3). Urinalysis an acid urine (pH 5.0), leukocyturia (2+/4+) mild proteinuria (1+/4+). also oliguric (urinary < 400 mL/day). Abdominal echography thick contracted bladder walls heterogeneous liquid collection in the left pelvic region. Two laparotomies were performed, abscess region found. Anti-peritoneal tuberculosis treatment rifampin, isoniazid pyrazinamide started. During follow-up, culture found be positive M. tuberculosis. Six months later patient abdominal pain dysuria. New laboratorial 187 8.0 potassium 6.5 mEq/L. Hemodialysis then The CT scan signs chronic nephropathy, dilated calyces thinning cortex both kidneys severe dilation ureter. developed neurologic symptoms, suggesting tuberculous meningoencephalitis, died despite support measures adopted. ESRD due secondary uropathy prolonged tract that caused by delayed clinical diagnosis, probably inadequate antituberculous drugs administration.