Guadarrama-Benítez B, Costilla-Montero A, Aragón-Castro MA, Gutiérrez-Rosales R, González-Ruíz GF, Carrillo-Ponce C, Morales-Padilla CA

Language: Spanish
References: 7
Page: 179-182
PDF size: 398.43 Kb.

ABSTRACT

Background: Renal tuberculosis makes up 27% of the extrapulmonary forms of this infection. It is asymptomatic until the destruction of the renal parenchyma causes symptomatology - a progression which takes place over a long period of time
Clinical case: The patient is a 41-year-old man, country dweller, presenting with type 2 diabetes (treated with oral hypoglycemic medication) and high blood pressure (treated with angiotensin converting enzyme (ACE) inhibitors). Patient was evaluated in the emergency room presenting with hematuria and acute urine retention for which 18 Fr transurethral catheter was placed. Despite bladder washout, bladder did not drain and so cystoscopy was performed. Significant urethral stricture, blood clots in the bladder (1000mL) and severely damaged bladder floor mucosa was observed. The left meatus was not able to be seen nor was any active bleeding site observed. Computerized tomography was ordered as part of hematuria protocol and magnetic resonance study was done when left tumor was suspected. Right nephrectomy was performed on the patient based on complex renal cyst diagnosis as well as due to the risk of massive bleeding.
Histopathological diagnosis stated acute and chronic granulomatous inflammation compatible with tuberculosis process that was confirmed by Ziehl-Neelsen stain.
Conclusions: Massive hematuria is uncommon in renal tuberculosis. Only 10% of patients present with macroscopic hematuria while 50% present with microscopic hematuria.

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