Kidney tuberculosis - urine condition and analysis. Kidney tuberculosis - symptoms and diagnosis of the recurrence of the kidney tuberculosis is heal

If a person has previously sick with tuberculosis in the lungs, then in 40% of cases, a secondary infection can develop when Koch's wand strikes the kidneys. With timely treatment, you can fully recover. The disease amazes people depending on the floor: only 5-10% of women who have pulled pulmonary tuberculosis, and 50% of men.

According to statistics, the disease is more often detected in patients aged 20-40 years, but recently began to meet kidney tuberculosis in children, which is associated with unfavorable ecology and unsatisfactory levels of life. The disease develops slowly without showing itself at first. Therefore, it is more often nephrotuberculese reveal in the last stages.

Factors provoking tuberculosis in the kidneys

The source of infection is bacterium, which falls into the kidney through blood, but the penetration of mycobacteria into the body can happen for a number of reasons:

• infection from the external source when the koch wand from the carrier falls into the "Victim" organism. Not always a person is ill ifing if there is a specific immunity - mycobacterium will remain inactive. If there is no such immunity, the risk of infection is growing. Provoking factors become urinary tract infections;
• infection from the internal source is a speech about the spread of koche wand in the body during the tuberculosis of the lungs and other organs. If the immunity is strong, the infection will die if not - the tuberculosis begins in the kidney.

Pathogenesis of tuberculosis in the kidneys

Pathology begins from the moment the mycobacterium falls with blood flow to the renal parenchyma. There is a bilateral formation of granuloma, but over time in one kidney the disease subsides, in the other - is actively developing. It is important how healthy the kidneys at the time of infection, for the koki sticks favorable conditions are created against the background of diabetes mellitus, infections, chronic diseases.

For the first stage, granulomatous inflammation is characteristic of the formation of a set of tubercles. The number of damage is determined by the number of mycobacteria in the parenchyma. Symptoms are greased - sometimes the temperature rises, the general weakness occurs.

In the lower back barely noticeable pain or there are no them at all. The initial stage is able to leak over the years, transforming into a chronic disease. Small lesions of defeat are healing and wrapped, but living mycobacteria can live in the kidneys for a long time.

For the second stage, the transformation of tuberculosis in the renal parenchyma into tuberculosis papillitis is characteristic. Formed in the cerebral substance of the so-called. The tubercles are affected by the papillary formations - they swell and impede the normal outflow of urine. At this stage, characteristic symptoms are not particularly manifested. The patient can notice the blood in the urine, but there is no pain. Since koch wand in large quantities penetrates the urine, the walls in the ureters and the bladder are damaged.

For the third stage, the merger of foci of inflammation is characteristic, the yield of necrotic masses into the lumen of loyal and cups. The cavity begins (so-called cavity), which indicates the beginning of the cavernous tuberculosis. From time to time, necrotic masses clog the ureter, which causes the pain similar. In the lower back hurts. With cavernous tuberculosis, there is a toxic jade and perifocal inflammation, which disrupts urinary, leads to renal failure.

If there is no treatment in the third stage, the cervix in the renal cups overlap, turning into cavities, full of pus. Here urine is not given, it says about the beginning of the fourth stage of pathology - fibrous-cavernous tuberculosis. Considering that fibrous education on the side of the pelvis is dense, the contents of the cavity can break through the kirok in the kidneys. As a result of a breakthrough, the pus falls into the flying tissue, a fistul move can open on the lower back.

On the fifth stage of nephrotuberculosis, the mistakes are detected - the area of \u200b\u200bthe lesion is filled with atrophic and fibrous formations. The kidneys at this stage refuse.

Are the kidney tuberculosis?

Despite the fact that nephrotuberculosis refer to infectious pathologies, it is secondary, and therefore the risk of infection is unlikely. By itself, mycobacterium is transmitted by air-dust, and also air-drip propagation is capable of continuously maintain viability in dust and mold clusters.

Risk of infection of tuberculosis kidney is unlikely

But from the kidneys, bacteria applies only with urine, blood - they can become a source of infection. Given this possible way to transfer tuberculosis surrounding should eliminate direct contact with blood and urine patient.

When using a general bathroom, you need to observe the hygiene of the hands, and in the room once a week it is disinfected by special means. Such measures are enough to prevent the spread of nephrotuberculosis.

Types of tuberculosis

According to the development of development and the rate of propagation of the disease, 2 forms of tuberculosis are distinguished:

• acute (binary) - begins with a large number of infectious pathogens in the kidney. There is a bilateral defeat, the formation of tubercles in the cortical region. Often an acute form over time passes, after which the scars remain on the kidney fabric;
• chronic (caseous) - if a small number of infectious pathogens fall into the kidneys, the inflammatory process develops longer, focusing in one of the pair of organs. Mycobacteria over time is striking the vast portions of the kidneys, as a result, ulcers appear and necrotic masses accumulate. The disease leads to renal failure, in the absence of therapy - to the failure of the authority.

How nephrotuberculese is manifested

At the very beginning of the disease, the symptoms of the kidney tuberculosis are not manifested, which is very dangerous because it makes it difficult to diagnose. Moreover, even the existing clinical picture is so general that the doctor's tuberculosis is suggested by a doctor can only if a history of tuberculosis is in an anamnesis. Common symptoms include the following:

• sluggish condition, general weakness;
• temperature 37.6;
• sometimes the hell is reduced;
• probably the occurrence of vomiting, diarrhea or constipation.

With nephrotuberculosis, patients have a common weakness.

Chronic form manifests itself more bright and specific, characterized by signs:

• frequent urge to urination, especially at night;
• in about 17% of cases, blood is detected in the urine;
• at about 20% of cases, blood pressure decreases at the last stages;
• a carbohydrate exchange is disturbed, which leads to severe weight loss;
• in 95% of cases - back pain;
• against the background of renal failure, spots on the skin appear.

Diagnostics

As mentioned above, due to the overall symptoms, the diagnosis of kidney tuberculosis is difficult. This applies not only to patient complaints, but also to the results of laboratory tests. In the urine there may be a little more than the norm of erythrocytes and proteins, the pathogenic microflora is not detected. Therefore, in order to clarify the diagnosis, you need to undergo a comprehensive examination. In particular, if the patient had a pulmonary tuberculosis, had contact with patients. The following picture is observed with laboratory studies:

• oxidation of urin and the presence of protein, but no microflora, which is usually detected against the background of inflammatory processes;
• increasing the number of erythrocytes in urine analysis;
• PCR diagnostics reveals a specific causative agent;
• IFA study determines the presence of antibodies to the causative agent;
• the provocative test, in which tuberculin is embedded under the skin, is investigated by the number of uniform elements.

Ultrasound kidneys

Instrumental studies show the following:

• due to ultrasound, the degree of damage to the body at the stage of formation of a cavron, but not earlier;
• x-ray is inex-informative in the initial stages of the disease, the lesion foci exhibit themselves only in the later stages, when the sealing of parenchyma and other changes are noticeably;
• CT and MRI appreciate the location of the cavern, the condition of lymph nodes near the kidneys for subsequent surgical intervention;
• nephrombraphy allows you to estimate the decrease in the functions of the organ;
• the liver biopsy makes no sense, but it is possible to explore the mucous membrane in the bladder - on the background of tuberculosis, Pirogov-Lagganz cells will be revealed here.

Usually, tuberculosis is detected by the method of differential diagnosis, eliminating such ailments as the diverticula of the cups in the kidney, medullary necrosis, etc.

Treatment of tuberculosis in the kidneys

The choice of treatment techniques is carried out by a doctor based on the available symptoms, the stage of the disease. There are conservative and operational methods of therapy. Basically, the course lasts 1 year with the need to stay in the dispensary. About 60% of the doctors prescribe an operation, but not because it is the best way out, and since the identification of the disease was too late. Usually therapy is assigned as follows:

• with tuberculosis, parenchyma and papilla are shown conservative treatment;
• with cavernous tuberculosis - conservative treatment, but sometimes a surgical intervention is shown to preserve the organ;
• in case of polycaveno tuberculosis, pionephrosis is shown the operation.

The specific choice of drugs is prescribed, taking into account the stages of kidney damage, available complications and other pathologies. The main goal becomes suppressing the vital activity of pathogenic microorganisms. Antibiotics are shown for this: streptomycin, etcutol, rifampicin. If the drug causes allergies, it is replaced by one of the following: Kanamycin, etionamide, cycloserine, etc.

Drugs destroy mycobacteria, on the site of the foci of infection, scars are formed. To minimize the volume of scar tissue, the complex of treatment adds NSAIDs and angioprotectors. During therapy, the kidney state is controlled if the volume of the urine released decreases, the urethral catheter or stent is set.

At the last stages of tuberculosis in the kidney, an operation is shown at which either part of the organ (cavernectomy) is removed or the entire (nephrectomy). Before appointed anti-tuberculosis treatment for 2-4 weeks, and after intervention - a full course of medication treatment to prevent the defeat of the remaining kidneys.

At the last stages of the disease, the organ removal operation is carried out

Recipes of traditional medicine from the renal tuberculosis do not help. Be sure to need an antibacterial preparation 1 or 2 rows. So far, such medicines have not opened, tuberculosis attributed to incurable diseases. From folk recipes you can use birch juice, propolis with oil - such funds will not kill bacteria, but they will not harm, but at the same time they will support immunity.

Prediction and prevention

The forecast of the further state of health with nephrotuberculosis is the stage of the disease. The earlier pathology is revealed, the less destructive processes it provokes in urinary organs, and with competent therapy you can fully cure.

An unfavorable forecast is more often about bilateral tuberculosis, when a pronounced destruction of renal parenchyma is observed. Anyone who has suffered nephrotuberculosis, rises to a nephrologist and a phthisira, regularly undergoes surveys.

Forecast to the patient will be able to provide a nephrologist doctor

You can talk about full recovery when urine indicators are within the normal range, and X-ray does not reveal tuberculosis relapses over the past 3 years.

The prevention of the tuberculosis of the kidney is to vaccinate and nonspecific measures aimed at preventing the lesion of the lungs of koche. Read more, how to protect your body from tuberculosis, you can have your doctor.

Kidney tuberculosis is a kidney parenchyma (main renal tissue) of an infectious nature caused by koha's stick (Tuberculosis, MBT, Mycobacterium tuberculosis). Among the extravalous forms of tuberculosis, this disease occupies the first place, by the affect of the lungs in 30-40% of cases. The renal tuberculosis, the leading form of the tuberculosis of the urogenital system, is much less infected than the bright-lighting option.

Etiology and pathogenesis of kidney tuberculosis

Ways transfer

The source of mycobacterium infection is a patient tuberculosis. Tuberculosis sticks in the kidney carried out through blood From another focus, as a rule, only the beginning to form a pulmonary. Such a process is due to the insufficiency of immunity at this stage of the disease. Also, the hematogenous distribution of the pathogen is possible even in the first few hours after infection through air or food.

Features of the renal blood flow cause penetration of mycobacteria into the kidney tissue and include:

• the presence of a set of small arteries (extensive microcirculatory channel);
• the presence of dense contact with the interstitial (filling space between the glomers, the tubules, etc.) by the tissue of blood vessels;
• presence in renal gloms of slow blood flow.

Such specific feature contributes to the fact that multiple foci on the kidney are formed, especially in the cortical layer.

1. Certain the opposite development is complete (if the focus has small sizes, there is a local or general immunity to this pathology or is noted mainly granulomatous inflammation).
2. Put inverse development partial with the formation of scars (in the presence of expressed proliferative processes (processes of cellular cells) or rapid activation of local immunity).
3. Cause the formation of case-necrotic masses (dead tissues of cotton consistency) with encapsulation (complete or incomplete) mycobacteria, as well as a long existence of the latter in the body.

The main factor provoking renal tuberculosis is the insufficiency of specific immunity. At the same time, secondary character has defeat of the Chesuchenic System (CLA) and Urinary Trackswhich is carried out mainly lymphogenic or less frequently in the direct contact of bacteria with mucous membranes.

In men in half cases, genitals (testicles with appendages,) are affected. In women, genital organs are affected only in 5-10% of cases. Because of the hematogenous path of transmission of the pathogen, both kidneys are infected, but the disease, as a rule, develops only on one side, is equally right or left.

Favorable conditions for the development of an infectious process create various pathological renal disorders such as urolithiasis, chronic pyelonephritis, etc.

Classification

Tuberculosis of the kidneys is classified with support for clinical and radiographic signs:

• Tuberculosis of the main kidney fabric (Parenhima), in which multiple foci are revealed in the crust and medullary kidney zone.
• Popillit tuberculosisAt which the renal panels are affected, and destructive changes are more pronounced.
• Cavernous (Sometimes an erroneous called "Caverreous") kidney tuberculosis, which is characterized by a merger of several foci of destruction, the formation of a fibrous capsule, as well as the lesion of the CHLS with the yield into the lumen of the casomic masses, which ultimately causes the formation of cavities (kaverne).
• Fibrozno-cavernous tuberculosis kidneys (Fibrozny tuberculosis) develops as a result of a preferential lesion of a neck several or one cup with their compression and overgrowth on the background of tuberculosis papillitis. A destructive-purulent cavity with a lack of outflow of its contents is formed from the zone of the destroyed papilla and the stretched cup.
• Kidding ocamotivation - the formation of tuberculos and caseoma due to the pronounced limitation of the pathological focus, the growth of tissues and the impregnation of the zone of damage to calcium salts.

Tuberculosis Kidney: Symptoms and Signs

Specific symptoms in the clinical picture of the renal tuberculosis are absent. In the early stages of the disease, a slight malaise may be occurring, rarely - subfebrile temperature, and in about a third of cases, any manifestations are not observed at all. When progressing the process may appear:

• blood in the urine (macrohematuria), the solemn form of which is noted in 17% of patients;
• painful sensations from the lesion in the lumbar region (at the initial stages - in 7%, and in later - in 95% of patients);
• urination disorders (dizuriy) - increased, soreness, accompanying the bladder damage.

Pains are characterized by a stupid character, but the destructive process in the kidney with a violation of the outflow of urine leads to an increase in symptoms up to the manifestations of the renal colic.

In 1% of cases in the early stages of the disease, arterial hypertension is observed, which in the launched cases is found already in 20%.

Diagnosis of renal tuberculosis

Suspicion of the kidney tuberculosis occurs if available:

• tuberculosis of lungs or other organs in history;
• contact with tuberculosis patients;
• such a factor as radiological signs of the transferred process when the lungs and others are examined.

Laboratory diagnostics

Answer the question of how to identify the tank tuberculosis, some laboratory signs of the disease help:

• In general, the urine analysis is determined by pronounced acidity, elevated content of leukocytes and protein, microhematuria (traces of blood detected only by analytical methods) in the absence of banal microflora.
• Sowing urine on tuberculosis (bacteriological research) reveals the presence of mycobacteria. Such a urine test for tuberculosis, unlike the usual sowing, remaining sterile without looking at the pronounced signs of inflammation (aseptic pyuria), is one of the leading diagnostic methods.
  The presence of mycobacterium tuberculosis defined by the PCR method (sensitivity of about 94%).
• The presence of antibodies identified by the IFA method.
• Confirmation of the infection of the body by means of tuberculinidiagnosis. Conducting a provocative test involves subcutaneous administration of tuberculin, followed by urine study for an increase in the urine sediment of uniform elements.

Ultrasound (Ultrasound Research) Kidney

In the early stages of tuberculosis, the ultrasound method is not detected. In the presence of cavernous lesions, echonegative formations of a rounded form are determined, surrounded by a dense capsule. In this case, the inhomogeneous nature of the cavity content may be observed.

Ultrasound is used in the diagnosis of kidney tuberculosis in order to determine the localization and degree of damage to the renal tissue, as well as the implementation of dynamic observation of the regression of the disease against the background of the treatment.

Radiological diagnostic methods

• Panoramic snapshot and nephrotomography (show seventure sites and strengthening the contour of the affected kidney).
• Excretory Urography.
• Retrograde ureteropelography.

CT and MRI kidney

Magnetic resonance and computed tomography make it possible to accurately determine the destructive focus and its relationship with trunk vessels, CLS and elements of the renal sine, as well as reveal the involvement of regional lymph nodes into the pathological process.

Dynamic nephrocintigraphy (radionuclide study of kidneys)

To estimate the functional characteristics of the kidneys, nephrocintigraphy is used. A decrease in the functional activity of the organ after the administration of tuberculin may be an indirect sign of the pathological process.

Morphological research

Since the renal tuberculosis is focal in nature, the use of biopsy is not effective and can provoke the spread of infection to the surrounding tissues. However, a sign of specific inflammation is to identify in 50% cases of the Giant Pirogov-Langgans cells in the morphological study of the bladder mucosa even in the absence of visible lesions of this organ.

Differential diagnosis

Tuberculosis kidney implies a differential diagnosis with:

• pyelonephritis (especially in the case of its complication by pionephrosis, the formation of purulent fistulas in the lumbar region);
• urethrohydronphrosis;
• hydronephrosis.

X-ray signs of renal tuberculosis should be distinguished from the manifestations of the complication of acute purulent pyelonephritis - medullary necrosis, anomalies of medullary substance (diverticulous cup, megakolikosis, megakylix, spongy kidney), dense and cystic tumor-like formations.

Only a combination of laboratory, clinical, radiological and ultrasound signs can serve as a basis for diagnosis.

Treatment of tread tuberculosis

The therapy of renal tuberculosis involves an individual approach using certain anti-tuberculosis agents.

The first row anti-tuberculosis means (basic) and reserve preparations are distinguished. Attribute to fixed assets isoprosis and other drugs based on isonicotine acid hydrazides, ethambutol, rifampicin, streptomycin. To the reserve - protionamide, ethionamide, cycloserine, kanamycin, aminoalicylic acid, etc., the use of fluoroquinolones (LEFLOXCINSACIN) is also promising.

Solving the question of how to treat tuberculosis kidney, it is necessary to rely on complex drug therapy, taking into account the stage and type of process, the severity of intoxication, individual dosage, the state of the patient himself, as well as other systems and organs of its body. In the treatment, it is important to remember the likelihood of the violation of the functions of the kidneys and the liver, the development of severe dysbacteriosis, allergic and other side effects.

Treatment of the disease requires the admission of non-specific anti-inflammatory funds and angioprotectors and has a long time from half to one year. Treatment with folk remedies can be carried out only as supportive therapy and requires a prior consultation of the doctor.

With the appearance of symptoms of violation of urine outflow, its restoration is shown by nephrostomy or the installation of a urethral catheter-stent.

The destructive process requires surgical treatment (nephrectomy) with preliminary anti-tuberculosis therapy for 2-4 weeks to prevent the lesion of the remaining kidney.

The local destructive process does not imply the removal of the entire kidney, but only a sanation (cullotomy) or resection of the lesion focus (cavernectomy).

Timely detection and successful conservative therapy serves as a guarantee of a favorable forecast.

Dispensary account

Treatment of kidney tuberculosis is carried out in a counter-tuberculous specialized institution. Patients who suffered the pulmonary form of the disease are placed after curing on dispensary accounting by periodic surveillance.

Tuberculosis is most often associated with lesions of the lungs, however, Koch's wand, which is the pathogen of this pathology, can also affect other internal organs and even eyes.

There is also such a disease as kidney tuberculosis - symptoms and treatment of such alerts have its own characteristics, and in the absence of therapy, this disease can cause serious complications.

What it is?

Tuberculosis Kidney (Code of ICD-10 - N29.1) is always a secondary disease, which develops against the background of the pulmonary tuberculosis. From the respiratory authorities, the pathogen - Koch wand - enters the kidneys on system blood flow, but it does not immediately happen, but in the period from three to ten years Since the initial defeat.

A little less than half of the patients with pulmonary tuberculosis, the disease turns into kidneys, and it does not depend on age and gender, but most often a poor is diagnosed in ages from 20 to 40 years.

Despite the fact that Koch's wand can with the same probability to get into any organ, most often pathological processes in the activity of this pathogen develop precisely in the kidneys, since the structure of their tissues is formed favorable reproduction environment Such microflora.

The koche wand is transmitted to the surrounding household and air-droplets and spreads between alive organisms only when open.

Some carriers of such a causative agent with a closed form of tuberculosis are not distributors, and in their body such a microflora may also not be active. But it happens that the person himself does not get ill, but bacteria can affect the internal organs of the person to which they pass.

About the features of the tuberculosis of the urogenital system, read in our article.

In addition to the form (closed and open), the renal tuberculosis is also classified and by types and stages. Distinguish the following forms of the disease:

• parenchymal (there are many foci of infection that affects the brainstuff);
• tuberculosis papillitis (infection of renal papillars);
• cavernous tuberculosis (there is a merger of several foci in more voluminous cavity capsules);
• fibrozno-cavernous form (cavities are closed, and pathogenic microflora is developed inside them);
• the mistakes (in renal tissue in limited areas, an infection remains, while in such areas there is a deposition of calcium salts).

Regardless of the form of renal tuberculosis is divided in stages:

• The first stage. Renal tissue is not destroyed and the structure of the organs is preserved.
• Second stage. Tissue necrosis begins and cavities are formed, in which such dead fabrics accumulate.
• Third stage. Kaverns merge into one cavity.
• Fourth stage. There is a complete destruction of the kidney, which from the inside turns into one large cavity, separated by the residues of the tissues.

The most obvious symptoms of the disease are manifested at cavernous tuberculosis kidneyIn which the bodies are formed in the organ and the ureter is additionally affected.

Before such a disease was called cathechno ChatterAnd at the stage, when all the cavities began to merge into one big, fatal outcome was to avoid it impossible.

But sometimes the disease passed into the form, and only after subsequent development in this background of fibrous-cavernous tuberculosis fell death.

Causes of the disease in women, men and children

In adults and children, the cause of the development of the disease is one: this is the defeat of the tissue of the kidneys as a pulmonary tuberculosis.

Less frequently, the disease first amazes other organs of the urogenital system, and then patients first and foremost develops or urolithiasis, and only the renal tuberculosis appears.

Provocate the development of pathology The following predisposing factors can:

• diseases of the endocrine system;
• supercooling of the body;
• walled diseases of the upper respiratory tract;
• violation of the power mode, malnutrition;
• the effects of toxic chemicals for a long time (for example, when working in harmful production).

Also, this pathology may arise against the background of most urological diseases and in injuries of the organs of the urogenital system.

What are the symptoms?

The beginning of the disease can manifest a long time in the form of weakness and general ailment, and the temperature if it rises periodically - then not higher than the mark of 37 degrees. Characteristic sign of tanner tuberculosis - fast weightless weight loss.

You can also observe the following symptoms:

• blood splashing in the urine;
• possible development;
• presence in the urine of pus;
• headaches and dizziness;
• pains in the area of \u200b\u200bthe belt, which become sharp when violating the outflow of urine.

In case the infection affects the bladder - pains can occur directly when urinating, and if pathology goes into a chronic stage - in patients periodically increases pressure.

Diagnostics

Diagnosis of the disease is complicated due to a large number of non-specific symptoms, so during the examination a number of procedures are appointed, and some of them only indirectly indicate the development of kidney tuberculosis.

Concerning accurate diagnosis Promotes the application of the following examination methods:

1. To identify koche sticks and an increased amount of red blood cells (sign of kidney lesions);
2. PCR diagnostics (identifies specific pathogens);
3. dynamic nephrocintigraphy (the level of reducing the functionality of the kidneys is determined);
4. enzyme immunoassay (to determine the presence or absence of antibodies in the body that could deal with the causative agent);
5. CT and (allow you to explore the cavity and get an idea of \u200b\u200btheir form and arrangement);
6. (To evaluate the degree of damage to organs in the late stages of the development of the disease).

When the foci of the lesion increases significantly and become noticeable when the ultrasound is fulfilled - additional rauchery diagnosis, which also allows you to determine the sealing seals of the parenchyma, but at the first two stages, radiation diagnosis and ultrasound are ineffective.

Treatment and forecast

In the course of treatment, patients are prescribed anti-tuberculosis means:

• Streptomycin;
• Etcutol;
• Popionamide;
• Rifampicin;
• Tubazide.

A better result can be achieved if combining these means with fluoroquinolone row antibiotics (LEFLOXCIN, OFLOXACIN, CIPROFLOXACIN).

Such drugs should be taken within a year and longer for the complete destruction of pathogenic microflora.

In cases where the disease is complicated by violations of the ureter, the patient can be carried out nephostomy and installation of the urinary stent. In advanced cases, when irreversible destructive processes are developing in the affected organs, the patient is completely removed by the patient.

Folk remedies

Many people use methods of medicine for the treatment of kidney tuberculosis as a latter. Sometimes such methods facilitate the state and even give a positive result.

Before being treated in this way, it is necessary to obtain the approval of the attending physician.

The most common means of traditional medicine under this pathology include the following:

• Bean pod sash, birch leaves, yarrow and black currant leaves are mixed in the same ratio (there must be about two tablespoons of the means), but these herbs do not need to grind.

The collection is simply poured 0.5 liters of cold water and adjusted to a boil, after which they hold on fire for another five minutes and then it is possible to stand in two hours. The lesion remedy is divided into three parts and drink three times a day per hour before meals.

• In equal proportions, drinking, nettle and herb is mixed, then two parts of cornflowers are added.

The mixture is grinding in the kitchen process to the powder state. On a day, it is necessary to use a tablespoon of this means, it does not dilute it, but richly picking up with ordinary water.

• Mixed one part of Veronica, Sage and Gusina Peppers - two tablespoons should turn out. The mixture is poured with two glasses of water and bring to a boil, and after a two-hour insolenization, the tool can be drunk in half a twenty-minute to each meal.

Do not count on the full effect of the funds of traditional medicine: Even if such decoctions and infusions and bring relief, it is only symptomatic therapywhich shows low performance in the absence of traditional drug drugs.

Sister process

Often, with complications of the kidney tuberculosis, the patient requires nursing care, and anyone close or not without special education can act as a transaction. The main thing is to remember highlights of care For patients:

• All prescribed drug drugs must be given only in the dosage that the doctor appointed, without reducing and without increasing it.
• Sometimes this pathology can lead to hemp. In such cases, the patient needs to ensure such a position in bed so that its head is above the level of the belt (it is enough to put several pillows under the human head).

In such situations, the diet remains the same, but completely excluded hot food: dishes should be cool, but not cold.

• If, when taking certain drugs, a patient appears by side reactions - they should be immediately informed about the doctor, and the drug intake must be terminated immediately.
• It is necessary to constantly ensure that the patient has a pure bed and underwear, if necessary, the patient needs to assist in the implementation of hygienic procedures.
• In the room in which the patient is located, it is necessary to regularly make wet cleaning and process the surface with disinfecting compositions is necessary to prevent the propagation of pathogenic microflora.

Diet and prevention measures

With the tuberculosis of the kidneys, patients are appointed diet number 11. (or table number 11). With such a diet, use of the following products is allowed:

• any types of soups;
• all cereals;
• vegetables and greens (preferably - in raw form);
• any meat and fish except for fatty varieties;
• eggs in any form;
• all sweets.

There are also no restrictions on flour products and drinks. Restrictions relate to the use of a large amount of salt, spices and essential oils (if possible, all this should be excluded at all from the diet).

As prevention, all patients undergoing treatment from kidney tuberculosis are necessarily put into account in the tube and systematically pass tests and are examined.

In general, with a timely planned visit to the doctor, the forecasts of the treatment of renal tuberculosis are favorable.

It should be borne in mind that vaccination protects on average in 95% of cases, therefore it is primarily important to comply with the rules of personal hygiene (wash their hands on returning home and not to give out its underwear, towels, hygienic and cosmetics).

Kidney tuberculosis is one of the most dangerous diseases of the kidneys, and the danger is not so much in the severity of pathological processes, but the impossibility of timely diagnosis.

At the first time of any violations of the kidney functions, it is necessary to immediately be examined by the fruit: perhaps this will allow you to recognize the ailment and to deal with its treatment in the light stages.

About approaches to therapy and observing patients with nephrotuberculosis Find out of the video:

Tuberculosis of the kidneys is the secondary manifestation of tuberculous infection in the body, which is a specific infectious inflammatory process. It is the tuberculosis of urinary organs that takes the first place among the extrapileous locations of the tuberculosis stick.

Tuberculosis of the kidney today is often diagnosed in a state of heavy cavernous forms when anti-tuberculosis drugs turn out to be ineffective and operational interventions are often organized.

The following categories of persons fall into the risk group:

• patients with chronic nonspecific diseases of urinary organs;
• persons who are diagnosed with other localization tuberculosis;
• persons contact with tuberculosis;
• children and teenagers who have a turn of tuberculin samples and / or increasing sensitivity to tuberculin.

Symptoms of renal tuberculosis depends on the type of disease development and from the activity of the infectious process. Symptoms of tuberculosis are also determined by the age and individual characteristics of the patient's body. These constitutional features determine the susceptibility of the patient's body with respect to infection, the types and paces of the development of the infectious process are determined.

Signs of tanner tuberculosis in adults

With the tuberculosis, the kidneys symptoms are usually similar to the manifestations of other renal diseases. The patient may have weakness, lethargy, fast fatigue, elevated body temperature (up to 37.5 ° C), there are stupid and indefinite pain in the lumbar region, in some cases headache, progressive weight loss.

Sometimes it is observed as a symptom of the renal tuberculosis, like blood in the urine - microhematuria, in urine analyzes, protein is detected - proteinuria, and leukocytes. The urine reaction is usually acidic. Sour urine with a significant content of pus, not decomposed even with a duty of standing - a characteristic symptom of the tank tuberculosis. Find in the urine tuberculosis sticks often represent difficulties.

In patients often observed the pallor and swelling of the face and eyelids, legs can also swell, sometimes hands, loin.

In the pleural and abdominal cavities it is possible to accumulate liquid. Sometimes blood pressure may increase due to edema, pain in the head may be intense, but short-term, dizziness and nausea may be. Insufficiency of blood circulation can lead to the defeat of the heart muscle and liver. Heart cuts slow down.

At the early stage of the renal tuberculosis, the release of daily urine is reduced due to edema, then the volume of urine allocated during the day exceeds the norm. Patients complain about the participated night urination. This is explained by the reflex from the kidneys on the bladder and tuberculous inflammation of the bladder, followed by a decrease in its tank.

The propagation of the inflammatory process on the urinary tract is evidenced by amplifying pain in the lumbar region and painful dizuriy - rapid urine.

Symptomatics of tanner tuberculosis in children

Tuberculosis kidney in children rarely occurs. The first symptoms that are observed with a given disease is the winding of urine and the presence in it in the pus. Subsequently, the deterioration of the overall state is noted. A child can notice an unhealthy pallor, rapid urination, a decrease in body weight.

An important reason to suspect the child's development of the kidney tuberculosis is a sudden incontinence of urine. In children with tuning tuberculosis, the bladder is often amazed, so painful sensations occur during urination, often a quiet character.

When palpation, the kidney feels pain, but independently it is not a source of pain.

When analyzing the urine of a sick child, the presence of fresh erythrocytes, small albuminuria, leukocytosis, is revealed. The presence in the urine Bacill Koch is the final confirmation of the disease.

The diagnosis of tuberculous kidney damage is complex and depends more from the experience of a specialist. In most cases, the disease can be detected in the already running stage, when the organ almost lost its function. Let us consider what methods are used by specialists when diagnosing kidney tuberculosis.

Primary inspection

The diagnosis of kidney begins with the clarification of patient and history complaints. When polling the patient, the doctor draws attention to the presence of a patient's patient a tuberculosis of light or other organs, long-term contacts with tuberculosis patients.

When examining a patient, a specialist with palpation diagnoses external genital organs, in men - prostate gland and seed bubbles. This is a very important method of diagnosing a kidney tuberculosis, which allows for the majority of men suffering from this disease, to identify it at an early stage.

Laboratory diagnostics

Laboratory diagnostics of the kidney tuberculosis includes bacterioscopy (detection of mycobacterium tuberculosis with microscopy), biological samples and bacteriological research.

In women, the fence of urine is produced by a catheter. Men take two portions of urine in two different vessels. If an increased number of leukocytes will be detected in the first portion of urine, then there is a inflammatory process in the urethra, if in the second portion - the disease of the prostate gland, as well as seminal bubbles. But the identification of pyuria in two portions of urine testifies to the pathological process in the kidneys.

Also, overall urine analysis makes it possible to detect its acidic reaction, which is characteristic of the tuberculous kidney damage. In addition, if the proportion of urine is reduced monotonously, this also testifies to the tuberculosis of the kidneys.

Tuberculinidiagnostic

The patient is subcutaneously introduced tuberculin, after which an additional study of urine is carried out. In order to improve the effectiveness of laboratory diagnostic methods, tuberculin provocative tests are carried out - they cause aggravation of the process, thereby increasing the number of bacteria in the urine.

Instrumental diagnostic methods

From the instrumental diagnostic methods, kidney radiography, an excretory urography, angiography, radioisotope research methods, ultrasound examination, computer and magnetic resonance tomography are used.

The study usually begins with renal radiography. Thanks to this diagnostic method, renewing a renal disease. The nature of the contours of the kidneys helps to estimate their magnitude and the condition of the octoral fatty fiber.

Angiography and radioisotope research methods are also used to detect the kidney tuberculosis.

Ultrasound examination is an auxiliary diagnostic method, allowing to estimate the localization and degree of kidney damage.

Computer and magnetic resonance tomography kidney allow revealing foci of defeat and evaluate the state of regional lymph nodes.

The process of treatment of tanner tuberculosis, namely, how therapy will be carried out, depends on the stage of this pathology. Conservative therapy is used at all stages, while operational treatment is only on III and IV stages.

Principles of conservative treatment:

• Simultaneous treatment with drugs of three groups: antibiotic, preparations of PSC and Gink group.
• Duration of therapy from 9 to 12 months.

Today, anti-tuberculosis drugs based on rifampicin, isoniazide, streptomycin, ethambutol, protionamide, pask, cycloserine are used in medical practice. Many anti-tuberculosis drugs have serious side effects, so their dosage, combinations and the duration of the reception are greatly different from the case towards the case, and largely depend on the individual sensitivity of the patient, the state of its kidneys, weight and age.

Under the action of some anti-tuberculosis drugs, and primarily streptomycin, there is a coarse scarring of tuberculosis foci in the walls of a cup, lochk, urinary bubble, ureter. It greatly affects the state of the kidneys. Scooter stenosis of the ureter causes hydraidonphortic transformation. Earlier, in order to prevent this complication, the patient was prescribed biological stimulants (vitreous body, aloe, etc.), adrenal hormones were prescribed physiotherapeutic procedures. Recently, the inner catheter "STENT" is used to prevent the appearance of the ureter's scarring, which provides urine outflow from the kidney.

Medical treatment of tuberculosis is always combined with other important healing moments, for example, day and nutrition, diet, climatotherapy, sanatorium treatment.

Control of the effectiveness of the designated treatment is carried out regularly, mainly according to the results of general analysis of urine, bacteriological research of urine, radiological studies, such as excretory urography. The criterion for recovery from tuberculosis and successful treatment of urinary tract is the absence of any changes within three years in the composition of urine and disorders recognized on the rates.

Since the possibilities of specific chemotherapy against tuberculosis are constantly increasing, indications and criteria for the operational treatment of urinary tract tuberculosis and the kidney also change. Today, non-simply organizing operations are possible, but also organ-powder. Although earlier, when streptomycin was not at the disposal of doctors, it threatened to generalize tuberculosis infection. Nephrectomy is gradually replaced by kidney resection, cobedomy and cavernectomy.

In order to be possible to carry out successful conservative therapy of nephrotuberculosis, an important condition must be observed, namely the good passage of urine affected kidney. In the case when it is not possible to restore urine passage through the inner drainage or the volume of lesions of the urinary tract is very large, produce a plastic reconstructive operation. Single scar separation of the ureteral implies resection of the affected area and the anastomosis of the ureter end to the end. Multiple and extended ureteral strictures can lead to the need to replace areas of the tissues of the small intestine. The lesions of the pelvic ureteral department imply a ureterocystoyanastomosis. In the case of a large distance from the bladder to the point of narrowing the ureter, the Boar surgery is carried out. In some cases, in front of the plastic surgery on the first stage of treatment to improve the results of chemotherapy, the functional and anatomical state of the kidney and the urine leads, percutaneous puncture nephrostomy is performed. With tuberculous microcustice (bladder wrinkling) often make the bladder plastic with sections of a thick or small intestine. Such an operation contributes to an increase in the volume of the bladder, the elimination of strokes, improves urine outflow from the upper urinary tract and the kidney itself.

In case of detection of tuberculosis in stage IV, nephrectomy is carried out.

Very often there is a secondary defeat of other internal organs. In the first place in terms of the frequency of lesion (up to 40% of cases), kidney and other organs of the urogenital system are worth. The pathogens of the disease - mycobacterium tuberculosis (MycobacTeRium tuberculosis), also called koch wand in honor of their discoverer, in the overwhelming majority of cases enter the hematogenic kidney (with blood flow).

The tuberculosis process can affect both one and both kidneys. After the primary infection in the organs of the urogenital system before the first signs of the disease, which are also not specific, can pass years, and sometimes dozens of years. That is why special attention should be paid to preventive examinations of patients ever suffered pulmonary tuberculosis.

Symptoms of renal tuberculosis

Symptoms of tank tuberculosis are nonspecific. This is a common weakness, a decrease in body weight, pain in the area of \u200b\u200bthe lower back, an increase in blood pressure and other clinical manifestations that may occur at any other pathology of this body.

Unfortunately, the symptoms of this disease are very nonspecific, because of which the diagnosis is often raised late, and the patient can be treated for a long time to be treated, and other renal diseases.

Common symptoms include:

• weakness, reduced performance, but at the same time the patient's condition remains quite satisfactory, they continue to go to work and with difficulty performing usual cases, writing off changes in well-being for fatigue;
• weight loss, loss of appetite, sweating;
• a long-term increase in body temperature, and it can be both persistent subfebelitis, and significant temperatures to 39 degrees;
• (Increased pressure without visible reasons, especially in young people, should bring to the idea of \u200b\u200bthe pathology of the kidneys).

Local symptoms also indicate that something is wrong with the kidneys, but it is not always possible to understand that the cause of the lesion is tuberculosis:

• pain in the lumbar region;
• discomfort, pain, difficulty when urination may indicate the defeat of the ureters and bladder, which are affected with tuberculosis only with the kidneys.

It should be noted that these symptoms are growing slowly and at first little bother patients. But if the defeat is bilateral, or the only kidney is amazed, the signs of illness can be more pronounced and develop much faster.

In order to associate these nonspecific symptoms, characteristic of most renal pathologies, precisely with renal tuberculosis, careful collection of anamnesis (contact with tuberculosis patients, transferred tuberculosis in the past, asocial lifestyle, in children - deviations from the norm in etc.) .

Diagnosis of renal tuberculosis

To identify the tuberculous process in the kidneys in the early stages is very difficult. A number of diagnostic procedures are usually held.

Analysis of urine

Diagnostics begins with: may be alert a pH shift in the acidic side, the appearance of protein, erythrocytes and pyuria (leukocytes and pussy), while the usual pathogenic flora is not determined.

Bakposev

We can identify the presence of mycobacteria with a bacteriological method (sowing on the nutrient medium). In most cases, the result in patients with tuberculosis turns out to be positive, but the negative result does not mean that the patient is healthy. The analysis should be repeated at least three times.

PCR

One of the most accurate methods for diagnosing kidney tuberculosis in the early stages is PCR (polymerase chain reaction), urine is most often used as a biological material in this situation. The advantage of PCR in the high sensitivity of the method, the result will be positive even if there will be only a few tuberculosis mycobacterium in the sample.

Tuberculinidiagnostic

In 90% of patients with tuberculin test, it is positive, but it does not indicate the localization of the process.

X-ray kidneys

Thanks to this method of examination, it is possible to identify an increase in the size, a change in the kidney contours, the formation in their parenchyma cavities (cavity), calcinates are signs of running tuberculosis, when the only effective treatment method is partial or complete removal of the organ. Simultaneously with kidney radiography, the snapshot of the lungs in two projections is required.

Ultrasound diagnostics

This method is also ineffective in the diagnosis of early kidney tuberculosis, but it is used to assess the effectiveness of conservative treatment.

CT scan

When the kidney tuberculosis, this method helps to diagnose the disease earlier than the changes will be noticeable to the ultrasound. With the help you can most accurately set the localization and prevalence of the process. However, the biopsy in suspected tuning tuberculosis is not done, since the risk of generating infection is great.

Thus, it can be concluded that the diagnosis of kidney tuberculosis is complex and not fast. The doctor makes a diagnosis on the basis of these multiple research and anamnesis. When initial changes in the kidneys are found according to the results of ultrasound, radiographic studies and tomography without the detection of mycobacteria in the urine can not be completely confident in the diagnosis.

Treatment of tread tuberculosis

In many cases, this disease is effectively conservative treatment, including anti-tuberculosis preparations, hepatoprotectors, drugs that feed the vascular wall, vitamins, immunomodulators.

The choice of therapeutic tactics is primarily depends on the process stage:

• I and II Stage of the Tuberculse of the Kidney, when it comes to diffuse damage to the parenchyma and papillas of the kidney, conservative therapy can be quite effective.
• On stage III, when there are single cavities, it is possible to preserve the part of the kidney against the background of drug therapy.
• IV Stage of the kidney tuberculosis, when it is all "eaten" by the caverns (cavities) and the addition of purulent processes is possible, the only method of treatment is the operation to remove the organ.

Therapy for tuning tuberculosis is prescribed only by a doctor, self-medication in this situation is unacceptable. Preparations are selected individually on the basis of determining the sensitivity of bacteria-pathogens to antibiotics. Treatment lasts at least 4-6 months (usually about a year), the reception of drugs is continuous.

Preparations used for the treatment of tuberculosis have a lot of side effects, therefore additional funds are assigned:

• hepatoprotectors;
• angioprotectors;
• multivitamin complexes;
• immunomodulators, etc.

The patient must necessarily receive good food rich in protein, vitamins and minerals. Sanatorium-resort treatment is also recommended.