Contralateral hydronephrosis with renal tuberculosis
Introduction
Brief introduction of contralateral hydronephrosis of renal tuberculosis Contralateral hydronephrosis of the kidney tuberculosis means that the contralateral hydronephrosis is a late complication of renal tuberculosis caused by bladder tuberculosis. According to the statistics of domestic data, in 1959, 1334 cases of renal tuberculosis were relayed to the contralateral hydronephrosis accounted for 16%. In 1962, 4,748 cases of renal tuberculosis were relayed to the contralateral hydronephrosis accounted for 13.4%. basic knowledge Sickness ratio: 0.001%-0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: bladder tuberculosis
Cause
Causes of contralateral hydronephrosis in renal tuberculosis
(1) Causes of the disease
Contralateral hydronephrosis of renal tuberculosis is a late complication of renal tuberculosis, caused by obstructive lesions of the bladder and ureteral tuberculosis, mainly through various pathological changes, affecting the urine drainage of the contralateral kidney, resulting in contralateral kidney and ureter Water.
(two) pathogenesis
1. The ureteral stricture tuberculous cystitis begins from the ureteral orifice of the affected side and gradually spreads to the trigone and the contralateral ureteral orifice. After the lesion invades the muscular layer and causes fibrous tissue hyperplasia, the contralateral ureteral orifice may develop due to scar formation. The stenosis hinders the urine drainage of the contralateral kidney, causing water to accumulate in the contralateral kidney and ureter. The ureteral dilatation generally develops gradually from the stenosis. Finally, the full length ureter dilates and the ureter itself is not conducive to urine drainage. .
2. The ureteral orifice is not fully closed. The ureter has a sphincter function due to the oblique inner wall segment in the bladder. When the bladder contracts, it flows out from the inside to the outside and does not flow back to the ureter and renal pelvis. The tuberculosis around the ureteral orifice may be due to Fibrosis causes the orifice to stiffen and lose the sphincter, leading to incomplete ureteral opening. Therefore, urine in the bladder can often flow back into the contralateral ureter and renal pelvis, causing water in the kidney and ureter.
3. The bladder tuberculosis with severe bladder contracture develops to the advanced stage, and the bladder muscle is replaced by a large amount of fibrous tissue. Eventually, the bladder contracture will occur, and the original storage and relaxation function will be lost. The intravesical pressure is often in a high pressure state, directly affecting the contralateral side. Renal and ureteral drainage, and thus secondary hydronephrosis.
Stenosis of the ureter, ureteral insufficiency and contracture of the bladder often occur simultaneously. During cystography, the contrast agent can be refluxed through the ureteral orifice to the ureter and renal pelvis.
4. Lower ureteral stenosis due to tuberculosis urinary continual reflux to the contralateral ureter, or lymphatic infiltration between the sheath and sheath, plus tuberculosis lesions near the contralateral ureteral orifice can be directly spread through the mucosal surface or infiltration of the submucosa, so that the ureteral orifice The above ureter also stenosis due to scar formation, causing water in the contralateral kidney and ureter.
The above four kinds of lesions often coexist. The secondary hydronephrosis secondary to renal tuberculosis is mainly caused by mechanical obstruction at the lower end of the ureter, urine reflux and bladder hypertension. When the hydronephrosis is severe, the renal parenchyma can be atrophied. Decreased function, eventually leading to renal failure.
Prevention
Kidney tuberculosis contralateral hydronephrosis prevention
1. Patients with tuberculosis or other tuberculosis should have a urine test to detect tuberculosis early, early treatment, and pay attention to the adjustment of rest and emotion.
2. Patients with renal tuberculosis should supplement high-calorie and high-quality protein, and need milk; need to add a lot of vitamin A, B, C, D; eat more fresh vegetables, fruits and all kinds of light and rich foods to keep the urine Unobstructed, strengthen diuretic effect, patients with chronic illness and physical deficiency should eat tonic.
Avoid warm, fragrant and dry diet, and avoid alcohol and tobacco.
3. Kidney tuberculosis, such as early diagnosis, positive and correct treatment, can be cured; if found too late, the kidney has been severely damaged or ureteral stricture, may require surgery, the prognosis is poor.
The fundamental measure to prevent genitourinary tuberculosis is to prevent tuberculosis. Due to recent advances in molecular biology, the Center for Disease Control (1989) proposed a strategic plan to eliminate tuberculosis within 20 years. Humans may use new prevention, diagnosis and treatment methods to eliminate it. Tuberculosis, the main measures are as follows: 1 to prevent the development of infection status into clinical disease, in the past using isoniazid 300mg daily for close contact with tuberculosis patients and other people who may develop tuberculosis for prevention and treatment, the incidence of tuberculosis decreased after use It has reduced the spread of the disease. Through the application of short-course chemotherapy, it has been found that intermittent medication can also achieve similar effects on daily use. The experimental study uses rifampicin and pyrazinamide twice a week, and the infection can effectively prevent infection for 2 months. To develop tuberculosis, if this method is used for preventive treatment, the spread of tuberculosis can be greatly reduced by using only 10 times of drugs. 2 Study of tuberculosis species, Genus-species specific, surface antigen, manufacturing monoclonal Antibodies and production of tuberculosis-specific DNA probes for early diagnosis of tuberculosis In 31998, Cole et al. determined the sequence of Mycobacterium tuberculosis DNA. The vaccine made of Mycobacterium tuberculosis DNA not only has the effect of preventing tuberculosis, but also can be used as a treatment to eliminate the Mycobacterium tuberculosis remaining after drug treatment. A breakthrough in progress will accelerate control and eliminate human tuberculosis infection.
Complication
Kidney tuberculosis contralateral hydronephrosis Complications, bladder tuberculosis
Once the hydronephrosis is complicated, if the obstruction is not relieved in time, the infection is difficult to cure, and the infection accelerates the destruction of the kidney, forming a vicious circle and even forming a pus. Contralateral hydronephrosis is a late complication of renal tuberculosis caused by bladder tuberculosis.
Symptom
Kidney tuberculosis contralateral hydronephrosis symptoms common symptoms urgency urinary incontinence hematuria dysuria urinary frequency
The clinical symptoms of nephrotic hydronephrosis and renal tuberculosis are the same. The local symptoms of hydronephrosis are not obvious, but the general condition is weaker. The prominent manifestations are severe symptoms of bladder tuberculosis, frequent urination, urgency. Urinary pain, frequent urination, urination several times per hour, accompanied by hematuria, and even urinary incontinence, a small number of patients have no bladder contracture, hydronephrosis is caused by ureteral stricture, bladder irritation is not obvious.
Another type of symptoms are anemia, edema, acidosis and other manifestations of renal insufficiency. If there is secondary infection, the condition is more serious. These symptoms can only indicate that both kidneys are damaged, but it is not possible to distinguish bilateral renal tuberculosis. It is also the contralateral hydronephrosis of the renal tuberculosis. The patient feels a low back pain when the bladder is full or urinating, indicating that the patient has vesicoureteral reflux.
Examine
Examination of contralateral hydronephrosis of renal tuberculosis
1. Urine examination: urine routine is acidic, a small amount of protein and red, white blood cells, 24-hour urinary tuberculosis examination is an important method for diagnosing kidney tuberculosis, and urine tuberculosis is indeed found to be decisive for the diagnosis of renal tuberculosis.
2. Phenol red kidney function test: phenol red discharge delay is the earliest change of contralateral hydronephrosis of renal tuberculosis, which can be used as a preliminary examination. After intravenous injection of 6mg phenol red, urine is collected at 15, 30, 60, 120min respectively. The phenol red concentration was measured, and the amount of phenol red in the urine samples at 15 and 30 min of hydronephrosis was very low, while the content of phenol red in the latter two samples was higher, and the phenomenon of phenol red discharge delayed and inverted occurred, and the kidney Dysfunction, total phenol red emission decreased, the content of fractionated specimens decreased, and the normal concentration was the highest in 15min, and then decreased in turn.
3. Intravenous urography. Most of the routine urography can not be developed. Because of the large dose of contrast agent itself, the solute load can play a diuretic effect, so that the hydronephrosis side is fully filled. In recent years, large doses of excretory urography have been used. Each kilogram of body weight is injected with 1ml of intravenous injection of contrast agent, most of which can improve the development, and can also use the delayed filming method. The specific time can be determined by reference to the phenol red discharge speed, and the film is usually delayed until 45min, 90min or even 120min. Clearer images.
4. X-ray examination: X-ray examination is decisive in determining the diagnosis of renal tuberculosis, determining the location, extent, extent of the lesion and the condition of the contralateral kidney.
5. B-ultrasound This examination is simple, economical, rapid and non-invasive. It can understand the degree of contralateral hydronephrosis, and can measure the thickness of the cortex, estimate the renal function status, and can also be used as an accurate positioning examination of puncture angiography.
6. CT and MRI examination For patients with acute anuria and renal non-developer, CT or MRI examination is feasible, and more detailed renal and ureteral lesions can be obtained. In particular, MRI can understand ureteral dilatation through urinary water imaging technology (MRU). The extent, location and extent of the stenosis provide a basis for developing a treatment plan, but at a higher price.
7. Renal puncture angiography is a good method for diagnosing renal tuberculosis and hydronephrosis with severe renal impairment. It can be performed under B-mode or X-ray guidance. Kidney puncture can obtain very clear renal pelvis. The ureter image can also clearly identify the location and extent of obstruction. It can be used for routine examination and bacterial culture of puncture-sucked renal pelvis. It can also be used for tuberculosis examination to exclude double-stomach tuberculosis. The urinary tract contrast agent is used for angiography, and the injected contrast dose should be less than the amount of urine sucked during the puncture, and the injected contrast agent can also be added with antibacterial drugs.
8. Retrograde angiography of the bladder is suspected of having a countercurrent flow of urine. Retrograde angiography can be injected into the bladder via a catheter, but it may aggravate the burden of the kidney and cause retrograde infection, which has rarely been used recently.
9. Cystoscopy: Congestion of the bladder mucosa, edema, tuberculous nodules and ulcers are obvious in the triangle area and the ureteral orifice of the patient. The late bladder tuberculosis makes the whole bladder congested and edema, showing a redness.
10. Isotope renal examination: When the renal function declines, the excretion is delayed or even non-functional, and the obstructive pattern appears in the contralateral hydronephrosis.
Diagnosis
Diagnosis and diagnosis of contralateral hydronephrosis of renal tuberculosis
There is no special clinical manifestation of contralateral hydronephrosis in renal tuberculosis. Any case of advanced renal tuberculosis, especially those with bladder contracture, should consider the possibility of contralateral hydronephrosis. Further examination is needed and bilateral kidneys are needed. Tuberculosis is identified.
Differential diagnosis
1 non-specific cystitis often occurs suddenly, repeated attacks, when light and heavy, hematuria often coincides with bladder irritation, and tuberculous cystitis caused by renal tuberculosis starts from the urinary frequency, gradually and continuously intensifies, hematuria is a symptom of bladder irritation After a while, but sometimes combined with non-specific infections, accounting for about 20% to 60%, the most common of which is E. coli infection,
2 Bladder irritation caused by urethral obstructive disease occurred after dysuria symptoms, most of them with non-specific infection, cystitis of bladder stones may have a sudden interruption of urinary tract during urination, accompanied by severe pain in the urethra, bladder tumor Bladder irritation symptoms appear after long-term painless hematuria. At this time, the tumor has infiltrated into the adjacent triangle area, and the renal tuberculosis hematuria is characterized by terminal hematuria after prolonged urination.
3 double kidney tuberculosis, isolated kidney and kidney tuberculosis or kidney tuberculosis contralateral hydronephrosis have symptoms of renal tuberculosis, and both may have renal dysfunction, often dysplasia or no imaging at the time of urinary angiography, therefore, despite its clinical It is very similar to the X-ray examination, but there is a principle difference in treatment, so it should be identified in the diagnosis.
