| BackgroundTuberculosis is one of the most common infectious diseases in the world.In the world,5%to 45%of TB patients have extrapulmonary tuberculosis(EPTB).Urogenital tuberculosis(UG-TB)is one of the most common extrapulmonary tuberculosis.In UG-TB,renal tuberculosis is the most common.How to diagnose tuberculosis accurately has always been a problem that needs to be considered by scientists and clinicians.In the urinary tuberculosis,KTB is very important,and the number of atypical cases of renal tuberculosis has increased significantly in recent years.Many patients have no typical severe frequent urination symptoms,only mild frequent urination or hematuria and low back pain as the main symptoms,some patients even have no obvious clinical symptoms.The clinical characteristics of typical renal tuberculosis patients are also not high,it is possible that the clinician is not aware of the lack of simple diagnosis for the general urinary non-specific infection.In the above situation,the misdiagnosis rate of renal tuberculosis is quite high,and even some patients misdiagnose for a long time,which leads to serious consequences.How to improve the diagnosis rate of renal tuberculosis is an urgent problem.PCR-TB-DNA has high specificity in the diagnosis of renal tuberculosis,but the positive rate of urine PCR-TB-DNA is different in many literatures.In order to improve the diagnosis rate of renal tuberculosis,152 cases of renal tuberculosis were collected,and the clinical characteristics and diagnosis and treatment of atypical renal tuberculosis were analyzed.The factors affecting the positive rate of TB-DNA detection in urine were studied.ObjectivesObjective to analyze the clinical manifestations and diagnostic methods of atypical renal tuberculosis,as well as the factors affecting the positive detection rate of urine PCR-TB-DNA.Methodsthe clinical data of renal tuberculosis patients treated in the First Affiliated Hospital of Zhengzhou University from 2014 to 2020 were retrospectively analyzed.①according to the clinical symptoms,152 patients were divided into two groups,the atypical group:the typical group=90:62.② From 152 patients,82 patients with renal tuberculosis who underwent urine tb-dna examination and were confirmed by pathology after operation were divided into two groups,positive group:negative group=34:48.Results1.Basic data:From 2014 to 2020,the high incidence age of renal tuberculosis patients in the First Affiliated Hospital of Zhengzhou University was 40-60 years old,with 91 people in this age group,accounting for 59.87%.Patients under 20 years old are rare,there are 5 people,no less than 17 years old hospitalized patients with renal tuberculosis,may be due to the long incubation period of tuberculosis.A total of 53 patients had a history of tuberculosis or chest X-ray showed abnormalities,including 33 cases in the atypical group and 20 cases in the typical group.Quinolones were commonly used before diagnosis,accounting for 82.2%.2.Clinical symptoms:The main clinical symptoms of renal tuberculosis were frequent urination(107 cases),urgency of urination(96 cases),urination pain(52 cases)and low back pain(75 cases),hematuria(38 cases).The main symptoms of 90 patients in atypical group were waist pain or bloating(51 cases)and frequent urination(45 cases),and 16 patients had no obvious clinical symptoms.The main clinical symptoms of 62 patients in typical group were frequent urination(62 cases),urgency of urination(49 cases)and pain of urination(40 cases).3.Laboratory examination:The urine routine of 152 patients were abnormal,109 cases of leukocytosis in urine,105 cases of microscopic hematuria,no clear report of renal tuberculosis.In this study,92 cases of 152 patients underwent T-SPOT test,86 cases were positive,the positive rate was 93.5%,there was no difference between the typical and atypical groups.Among them,122 cases received urine PCR-TB-DNA examination,45 cases were positive,77 cases were negative,the positive rate was 36.89%.There was significant difference between the typical and atypical groups(P<0.05).4.Imaging examination:Ultrasound examination of 152 patients showed abnormalities,but lack of specificity.In this study,152 cases were examined by CT or CTU.There were 75 cases of patients examined by CT,all of them reported abnormal,of which 44 cases directly reported suspected renal tuberculosis,accounting for 58.67%.There were 117 cases of CTU examination,all of them reported abnormal,81 cases of renal tuberculosis or renal tuberculosis to be excluded,accounting for 69.23%.Among 137 cases detected by SPECT-CT,97 cases had severe renal function damage with unilateral renal GFR less than 30ml/min,60 cases in atypical group,accounting for 75.0%,and 37 cases in typical group,accounting for 64.9%.There were 62 patients who had received cystoscopy before diagnosis,53 of them showed abnormal mucosa,47 of them received tissue biopsy,and 19 of them reported bladder tuberculosis.There was no significant difference between the two groups(P<0.05).Ureteroscopy was performed in 8 cases because of ureteral obstruction without calculi,and 6 cases were pathologically diagnosed as ureteral tuberculosis.5.The influencing factors of the positive rate of urine TB-DNA examination were analyzed.A total of 82 cases,aged 19-67 years,with an average age of 47.44 ±12.29 years,were included,including 34 males and 48 females(male:female=1:1.4).In the positive group,there were 26 cases,12 males and 14 females,19 cases were treated with fluoroquinolones and 7 cases were not treated before diagnosis;in the negative group,there were 56 cases,22 males and 34 females,70 cases were treated with fluoroquinolones and 7 cases were not treated before diagnosis.There was no significant difference in gender,average age,left and right side of the affected kidney between the two groups(P>0.05).There was significant difference in the treatment of quinolones and hydronephrosis before diagnosis between the two groups(P<0.05).6.According to the data of 1316 patients who underwent urine TB-DNA test in the outpatient or ward of our hospital from January 1,2019 to July 22,2020,72 of them were positive,and 63 of them were successfully obtained the follow-up examination results,all of them were patients with renal tuberculosis,and 44 of them were complicated with pulmonary tuberculosis.Most of the tuberculosis patients were transferred to infectious disease hospitals,and no follow-up treatment was recorded.Conclusions1.The high incidence age of renal tuberculosis is 40-60 years old,female patients are more than male,and children are rare,which may be due to the long incubation period of tuberculosis.There is no significant difference in the onset age between the typical group and the atypical group.2.Most patients in the atypical group had low back pain and no obvious symptoms.The atypical group had more hydronephrosis and ureteral damage.3.The atypical group took quinolone antibiotics before diagnosis,which may play a role in covering up the disease.4.CT,especially CTU,has great advantages in the diagnosis of renal tuberculosis.5.The factors influencing the positive rate of urine TB-DNA detection in patients with renal tuberculosis are hydronephrosis and the application of quinolones antibiotics.6.The specificity of urine TB-DNA was 100%. |
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