Renal tuberculosis in the modern era

Area of Science:

• Nephrology
• Infectious Diseases
• Public Health

Background:

• Tuberculosis (TB), caused by Mycobacterium tuberculosis, remains a major public health concern, especially in developing countries.
• Extrapulmonary TB cases are increasing due to human immunodeficiency virus (HIV) infection and organ transplantation leading to immunosuppression.
• Urogenital TB accounts for 27% of extrapulmonary cases, with renal involvement being a significant manifestation.

Purpose of the Study:

• To highlight the underdiagnosis of renal tuberculosis (TB) in healthcare settings.
• To emphasize the clinical presentation of renal TB, including sterile pyuria and microscopic hematuria.
• To stress the importance of physician awareness in diagnosing urinary tract TB, particularly in at-risk populations.

Main Methods:

• Diagnosis of urinary tract TB relies on identifying pyuria in the absence of common bacterial infections.
• Clinical suspicion is crucial, especially in patients with unexplained urinary tract abnormalities.
• Review of common diagnostic findings and recommended first-line anti-TB drugs.

Main Results:

• Renal TB is frequently underdiagnosed, despite characteristic symptoms like sterile pyuria.
• Microscopic hematuria can also be present in patients with renal TB.
• The diagnostic challenge lies in differentiating TB-related pyuria from other causes.

Conclusions:

• Increased physician awareness is critical for suspecting and diagnosing renal TB.
• Patients with unexplained urinary tract abnormalities, immunosuppression, or from TB-endemic areas should be evaluated for renal TB.
• Prompt diagnosis and treatment are essential for managing this underrecognized condition.