Clinical Symptoms And Imaging Analysis Of Patients Undergoing Nephrectomy For Tuberculosis

BackgroundUrogenital tuberculosis(UGTB)is one of the most common extrapulmonary tuberculosis(EPTB).Approximately 2%to 20%of tuberculosis will spread to the kidney through blood,and mycobacterium tuberculosis descend into the ureter,bladder,and urethra with the urine flow,and can retrograde to the male reproductive system through the ejaculatory duct.Therefore,kidney tuberculosis(KTB)is very important in the treatment of UGTB.However,due to its insidious onset,clinical manifestations are not specific,most of them are manifested as lower urinary tract symptoms and the rate of misdiagnosis is high.Often,the disease progresses to the middle and late stages before being diagnosed.Also,due to nonstandard treatment of tuberculosis,drug-resistant tuberculosis and multi-drug resistant tuberculosis strains have increased,the effect of simple medical treatment is not satisfactory,so surgical intervention is usually performed in some cases.The surgical methods are mostly nephrectomy,but indications for this are still controversial.Therefore,we retrospectively analyzed the clinical data of 101 patients undergoing nephrectomy to elaborate their clinical and imaging features.ObjectiveTo compare clinical manifestations and imaging features of patients undergoing nephrectomy for tuberculosis with dysfunctional or non-functional kidney?MethodsA single-center retrospective study was conducted to collect clinical data of 101 patients who underwent nephrectomy for renal tuberculosis at the First Affiliated Hospital of Zhengzhou University from January 2012 to December 2018.All renal specimens were confirmed renal tuberculosis by postoperative pathology.According to the glomerular filtration rate(GFR)measured by the SPET-CT dynamic scan of the impaired kidney,all patients were divided into two groups:the dysfunction group(GFR>20 mL/min)and the non-function group(GFR?20 mL/min).To summarize the basic data,clinical manifestations,laboratory examinations and CT imaging features of all patients with renal tuberculosis,and analyze the differences between two groups.Results1.Basic data:A total of 101 cases were included,including 42 males and 59 females,aged 17-75 years,with an average age of 46.41±13.2 years.Fifty patients in the dysfunction group had an average GFR 30.94 ± 8.06 mL/min;51 patients in the non-function group had an average GFR 10.65 ±5.78 mL/min.2?Clinical manifestations:The course of disease of 101 patients before nephrectomy ranged from 0.1 to 108 months,of which the median course of disease was 11 months in the dysfunction group and the median course of 24 months in the non-function group.There was a statistically significant difference between the groups.(P<0.05).The dysfunction group:30 patients with LUTS symptoms(60.0%),22 patients with low back pain(44.0%),9 patients with gross hematuria(18.0%),13 patients with fever(26.0%),and 16 patients with other systemic symptoms(32.0%);The non-function group:35 patients with LUTS symptoms(68.6%),17 patients with low back pain(33.3%),10 patients with gross hematuria(19.6%),14 patients with fever(27.5%),12 other systemic symptoms(23.5%)The difference in the above data was not statistically significant(P>0.05).3?Laboratory examination:The dysfunction group:9 patients with acidic urine(18.0%),41 patients with microscopic hematuria(82.0%),26 patients with positive urine protein(52.0%),41 patients with abnormal urine leukocytes(82.0%),serum creatinine value was 83.20±19.86?mol/L,the positive rate of jieming three items(TB.check test,TB-DOT test,TB-Ab test)was 71.4%,and the positive rate of T-SPOT was 94.4%;The non-function group:10 patients with acidic urine(19.6%),39 patients with microscopic hematuria,17 patients with positive urine protein(33.3%),35 patients with abnormal urine leukocytes(68.6%),serum creatinine value 86.85±32.98?mol/L,the positive rate of jieming three items was 81.5%,the positive rate of T-SPOT was 77.8%.The difference in the above data was not statistically significant(P>0.05).4?Imaging examination:CT findings of the two groups were unilateral or bilateral hydronephrosis,renal calcification and ureteral stricture,and some patients had tuberculous autonephrectom,bladder contracture and epididymal tuberculosis.The rate of autonephrectom was significantly different between the two groups(P<0.01).The dysfunction group:renal cortical thickness 8.92 ± 4.97mm,CT enhancement degree 77.54 ± 38.23Hu.The non-function group:renal cortical thickness 5.23 ± 2.23mm,CT enhancement degree 35.22 ± 19.44Hu;The difference between the two groups was statistically significant(P<0.05).The renal cortical thickness and CT enhancement degree of impaired kidney in the dysfunction group were greater than those of the non-function group.The GFR of impaired kidneys was significantly positively correlated with renal cortical thickness(r=0.495)and CT enhancement degree(r=0.626)(P<0.05)Conclusion1?In patients undergoing nephrectomy for renal tuberculosis,the degree of impaired renal function has no correlation with severity of the clinical manifestations and laboratory results,but is correlated with the thickness of the renal cortex and the degree of CT enhancement during the arterial phase,suggesting that CT plays a significant role in the diagnosis and treatment of renal tuberculous.2?Except for tuberculous autonephrectomy,there was no significant difference in clinical data between patients with dysfunctional kidney and patients with non-functional kidney,suggesting that the impaired renal function is not the only indication when performing nephrectomy for tuberculosis and comprehensive consideration is essential.