Tuberculosis of kidneys and uric ways

Description:

Tuberculosis of uric system makes 30-40% of extra pulmonary forms of a disease and takes among them the 1st place. Men and women suffer equally often, at the same time the greatest distribution tubercular defeats of uric system are noted at persons from 20 to 40 years while incidence among children remains low.

High prevalence of tuberculosis of kidneys and uric ways, and also its quite often late diagnosis conducting to an invalidism of the able-bodied contingents of the population gives to a problem not only the medical, but also social importance.

Symptoms of Tuberculosis of kidneys and uric ways:

Tubercular defeat of bodies of uric system has no pathognomonic symptoms. At early stages of a disease perhaps asymptomatic current. However at development of initial destructive changes quite often there is a bezbolevy total gross hematuria owing to a vessel erosion at an ulceration of a renal nipple. Cavitation in kidneys usually is followed by pain in lumbar area and symptoms of the general intoxication of an organism (insignificant rises in body temperature, increased fatigue, weakness and weight loss). Besides, at the expressed destruction of a renal parenchyma there can be an intensive total gross hematuria.

Disturbance of urodynamic because of specific stenoses of upper uric ways is shown by heavy feeling in a waist, periodically repeating renal colic with fervescence to febrile figures. At bilateral disturbance of a passage of urine into the forefront symptoms of a chronic renal failure quite often act.

Tubercular damage of a bladder is shown, generally by the dysuric phenomena: imperative desires to an urination, a pollakiuria and a strangury. Patients with tubercular - cystitis complain of constant pain over a bosom and a periodic terminal gross hematuria.

Thus, the symptomatology of tuberculosis of bodies of uric system can proceed under various clinical "masks" in this connection the greatest value is gained by laboratory and hardware and tool methods of a research.

Reasons of Tuberculosis of kidneys and uric ways:

Specific activators of tubercular process in bodies of uric system preferential are mycobacteria of tuberculosis of human type (M. of tuberculosis). The role of a mycobacterium of bull type (M. of bovis) and atypical activators from the sort Micobacterium is extremely insignificant.

The vast majority of cases of a nefrotuberkulez are secondary in relation to clinically shown or latent centers of tubercular process existing in an organism usually located in lungs. It is noted that renal defeats arise on average 8 years later after primary pulmonary tuberculosis. With a blood flow of a mycobacterium get to the glomerular device of both kidneys located in their bark where the smallest tubercular ochazhka are formed. They can spontaneously resolve at a normality of protective mechanisms of an organism. In case of frustration haemo - and urodynamic of kidneys, and also disturbances in immune system tubercular process of cortical substance extends on brain where inflammatory process in renal nipples (a tubercular papillitis) as a result develops. Further the inflammation gradually gains destructive character and covers all thickness of pyramids of kidneys with caseous disintegration of the last and formation of cavities which can be as isolated, and reported with pyelocaliceal system. Besides, when progressing specific process education in a renal parenchyma of a large number of the cavities tied with each other or a polycavernous form of tuberculosis with the subsequent outcome in a tubercular pyonephrosis is possible. When healing cavities there is a calcification of the caseous centers that, however, does not mean their sanitation as in the depth of petrifikat viable mycobacteria quite often remain. Despite bilateral damage of kidneys a tuberculosis infection, clinicoradiological manifestations have most often unilateral character.

It is long proceeding нефротуберкулез causes gradual involvement in specific process of a pelvis and an ureter. Spread of an infection is carried out on the absorbent vessels lying in a submucosal layer of upper uric ways. On a mucous membrane of the specified bodies there are multiple hillocks and ulcers when which healing deformations and narrowings of their gleams form.

Bladder tuberculosis always is secondary in relation to damage of a kidney and an ureter. Rather late involvement of a bladder is connected with high resistance of his mucous membrane to a mikobakterialny infection. Distribution on body of a specific infekt happens in the lymphogenous way on submucosal upper uric ways. The tuberculous focuses which are formed in a bladder have an appearance of hillocks which can ulcerate. Caseous disintegration of a mucous membrane can progress both on the area, and in depth with involvement of a muscular layer.

Treatment of Tuberculosis of kidneys and uric ways:

Medical tactics at tubercular damage of kidneys and uric ways depends on a process stage. At early stages of development of a specific disease (the I-II stage of a nefrotuberkulez) effective is a medicamentous therapy. Co-administration of several drugs of different groups for long term is standard (at least on 9-12mes). At treatment of tuberculosis of bodies of an urinary system most often apply medicines of new generation: isoniazid, rifampicin, Ethambutolum, Prothionamidum, Pyrazinamidum, etc. For increase in efficiency quite often they are combined with ftorkhinolona (ciprofloxacin, ofloxacin, ломефлоксацин, etc.). At the same time did not lose the relevance and such antitubercular drugs as streptomycin and Tubazidum.

It is necessary to consider that conservative therapy of tuberculosis leads to gradual substitution of the infectious centers cicatricial fabric. In this regard it is reasonable to carry out treatment of tubercular defeat of an ureter for prevention of its rough scarring against the background of drainage by an internal ureteric catheter stent.

For control of efficiency of therapy to patients the laboratory analyses of urine including the methods directed to detection of mycobacteria of tuberculosis, and also ultrasonic and X-ray inspections are regularly carried out. Criteria of an izlechennost from a disease are normal results of analyses of urine and lack of progressing of process according to beam diagnostic methods for 3 years.

Only patients in late stages of a nefrotuberkulez are exposed to surgical treatment. At the III stage of process preference is given to such organ-preserving operations as a nephrectomy, a kavernektomiya and a cavernotomy. Total destruction of body is the direct indication to a nephrectomy.

Wrinkling of a bladder owing to its total tubercular defeat considerably breaks quality of life of patients. In this regard at a microcisyew apply the intestinal plastics providing increase in volume of a bladder.

For 2-3 weeks before any operation for tuberculosis of bodies of uric system, and also for 3-5 years after it carrying out antitubercular chemotherapy is necessary.

The forecast at tuberculosis of bodies of uric system. The main predictive factor at tuberculosis of kidneys and uric ways is the disease stage. At early stages of development of a nefrotuberkulez and in the absence of rough destructive changes in an ureter and a bladder adequate conservative therapy can lead to full treatment.

The expressed destruction of a renal parenchyma do doubtful preservation of the struck body. Predictively for life of the patient clinically bilateral defeat of bodies of uric system, in particular at late stages is extremely adverse.