Asian J Urol  2017, Vol. 4 Issue (2): 135-136   PDF    
Autonephrectomy due to urogenital tuberculosis
Sinha Rahul J.a, Jhanwar Ankura, Singh Vishwajeeta, Sharma Kuldeepb, Prakash Gaurava, Mehrotra C.N.c     
a Department of Urology, King George's Medical University, Lucknow, India;
b Department of Urology, Rabindra Nath Tagore Medical Institute, Rajasthan, India;
c Hind Institute of Medical Sciences, Lucknow, India

A 45-year-old male presented with history of left flank pain for 1 year, which was mild dull aching in nature. Plain X-ray film of the urinary tract (Fig. 1) was suggestive of diffuse calcification in the left renal area (broad arrow) along with calcification in the ipsilateral ureter region (thin arrows). Chest X-ray was normal. Non-contrast computed tomography (CT) of kidney, ureter and bladder (axial section) showed replacement of entire left kidney with calcification (Fig. 2A). After contrast injection, the left kidney was not visualised while normal contrast uptake was seen in the right kidney (Fig. 2B) (coronal section). CT urogram showed calcification of the left kidney and ureter and normal excretion of contrast by the right kidney (Fig. 3). Urine report was positive for acid fast bacilli staining. Purified protein derivative skin test for tuberculosis was positive. Patient was managed with 6 months of multi-drug antitubercular therapy (ATT) along with opioid analgesics, as and when required. Nephrectomy was not required in this patient. Patient is symptom free and doing well at 1 year of follow-up.

Figure 1 Plain X-ray film of urinary tract is suggestive of diffuse calcification in left kidney (broad arrow) along with calcification in ipsilateral ureter region (thin arrows).

Figure 2 (A): Non-contrast computed tomography of kidney, ureter and bladder (axial section) showing replacement of entire left kidney with calcification. (B): Contrast film showing non-functioning left kidney with normal contrast uptake by right kidney (coronal section).

Figure 3 Computed tomography urogram showing classical opacification of left kidney and ureter by calcification and normal excreting right kidney.

Our case illustrates classical radiological imaging of urogenital tuberculosis (UGTB) with autonephrectomy which is rare nowadays. Management of such patients should be individualised; which was nonsurgical after full course of ATT in our patient.

UGTB is the second most common extra-pulmonary tuberculosis after lympho-nodal affection [1]. Various radiological signs described include classical putty kidney leading to autonephrectomy, in which extensive, diffuse and uniform parenchymal calcification occurs [2]. However, such presentation is historical. Nowadays, UGTB is diagnosed at an earlier stage where medical therapy with reconstructive procedure generally restores renal function to a certain degree.

We present a case of UGTB with autonephrectomy in an immunocompetent patient with no family history; the patient belongs to an endemic zone of tuberculosis. Plain Xray film showed classical putty like left renal calcification along with ureteric calcification. CT showed replacement of entire left kidney with calcification. Patient was managed by ATT.

Conflicts of interest

The authors declare no conflict of interest.

References
[1] Sharma SK, Mohan A. Extra-pulmonary tuberculosis. Indian J Med Res 2004; 120 :316–53.
[2] Merchant S, Bharati A, Merchant N. Tuberculosis of the genitourinary system-urinary tract tuberculosis: renal tuberculosispart I. Indian J Radiol Imaging 2013; 23 :46–63. DOI:10.4103/0971-3026.113615