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Thursday, July 24, 2014
TB of the kidney? Should I pursue this?
In 1984 after a 12week college course trip to Costa Rica I converted to a positive tb skin test. At that time a 1 yr course of INH was reccommended and taken. Five years ago I was diagnosed with a pulmonary nodule and pneumonia thought to be cocci(common to desert dwellers such as myself). A blood test for this however was negative. I have been followed closely for the nodule with fairly frequent X-rays with no change. Fall of 05 I began having frequent bouts of flank pain, a kidney ultra sound in 6/06 showed something minor, but I can`t find the results. As of last summer I began having headaches from my neck to the top of my head, thought to be migraine in nature. Now I feel what I think to be bladder spasms. I am tired most of the time and have an overwhelming sense of heat in my body much of the time without fever. My MD has lost interest in helping me. I have one more appt to see a Rheumatologist, then I feel I`ll be put on the crazies list! I know there is something not right here as normally I have good health and energy. I had a reprive of most symptoms from last Nov until this May. Should I pursue my latest thoughts of Kidney TB or similar dx?
Tuberculosis of the kidney is a rare form of tuberculosis. When it occurs there is often active pulmonary disease present as well. The symptoms can be quite variable depending on the part of the urinary tract that is involved. Many patient's have no symptoms. Some patients have pain, pain with urination, blood or white blood cells in the urine.
Evaluation for renal tuberculosis involves checking the urine for white blood cells without evidence of a regular bacterial infection in the bladder (this is called sterile pyruia). If this is present then several morning urine specimens can be sent for culture for the TB germ.
The treatment you took to prevent TB (12 months of Isoniazid) is highly effective. This regimen reduces rates of subsequent active TB by about 95%. Based on the preventive treatment you took and rarity of renal tuberculosis overall, the chance that you have TB of the kidney's is low.
I cannot advise you specifically about whether you should pursue evaluation for this problem or not. I hope that the above information is helpful to you.
Catherine A Curley, MD, MS
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University