Urogenital tuberculosis is the third most common form of extrapulmonary tuberculosis, preceded only by lymph node involvement and tuberculous pleural effusion. Its incidence ranges from 2% to 20% among individuals with pulmonary tuberculosis. In patients with hematogenous dissemination, involvement of the urogenital tract occurs in 25% to 62% of cases. Renal tuberculosis is more frequent in men, at an approximate ratio of 2:1 compared with women, with a mean age of 40 years. Only 36.5% of patients with urogenital tuberculosis have a prior diagnosis of pulmonary tuberculosis or suggestive imaging findings. Diagnosis is often overlooked, requiring a high index of clinical suspicion for early and effective management. A 29-year-old female patient of Haitian nationality, living in Brazil, sought medical care reporting weight loss, hypotension, night sweats, dry cough, and right flank pain. Chest radiography showed findings compatible with pulmonary tuberculosis. Urinalysis revealed leukocyturia (>100/field), hemoglobinuria (3+/4+), proteinuria (+/4+), and pyuria. Urine culture identified growth of Mycobacterium tuberculosis . Chest computed tomography demonstrated centrilobular alveolar opacities, some progressing to small areas of consolidation. HIV serology was negative. Standard treatment with the RIPE regimen was initiated. However, the patient developed complicated pyelonephritis, with deterioration of renal function (creatinine 7.0 mg/dL) and severe refractory hypervolemia, requiring hemodialysis. Due to toxicity of the initial regimen, treatment was changed to levofloxacin, meropenem, and linezolid. Right nephrostomy and placement of a left double-J catheter were performed. The patient showed progressive clinical improvement, allowing hospital discharge and outpatient follow-up. The diagnosis of renal tuberculosis should be based on clinical suspicion, particularly in patients with atypical urinary tract infection, constitutional symptoms, and compatible epidemiological history. Confirmation is preferably achieved through urine culture for Mycobacterium tuberculosis using Löwenstein–Jensen medium. Other diagnostic tools include nucleic acid amplification tests in selected cases and histopathological examination of renal biopsy specimens.
Moraes et al. (Sun,) studied this question.