Renal TB is difficult to diagnose, because many patients present themselves with lower urinary symptoms which are typical of bacterial
cystitis. We report a case of a young woman with renal TB and
ESRD. She was admitted with complaints of adynamia,
anorexia,
fever,
weight loss,
dysuria and generalized
edema for 10 months. At physical examination she was febrile (39 degrees C), and her abdomen had increased volume and was painful at palpation. Laboratorial tests showed serum
urea = 220 mg/dL,
creatinine = 6.6 mg/dL,
hemoglobin = 7.9 g/dL, hematocrit = 24.3%, leukocytes = 33,600/mm(3) and platelets = 664,000/mm(3). Urinalysis showed an
acid urine (pH = 5.0), leukocyturia (2+/4+) and mild
proteinuria (1+/4+). She was also oliguric (urinary volume < 400 mL/day). Abdominal echography showed thick and contracted bladder walls and heterogeneous liquid collection in the left pelvic region. Two
laparotomies were performed, in which
abscess in pelvic region was found. Anti-peritoneal
tuberculosis treatment with
rifampin,
isoniazid and
pyrazinamide was started. During the follow-up, the urine culture was found to be positive for M.
tuberculosis. Six months later the patient had complaints of
abdominal pain and
dysuria. New laboratorial tests showed serum
urea = 187 mg/dL,
creatinine = 8.0 mg/dL,
potassium = 6.5 mEq/L.
Hemodialysis was then started. The CT scan showed signs of chronic nephropathy, dilated calyces and thinning of renal cortex in both kidneys and severe dilation of ureter. The patient developed
neurologic symptoms, suggesting tuberculous
meningoencephalitis, and died despite of support measures adopted. The patient had
ESRD due to secondary uropathy to prolonged
tuberculosis of urinary tract that was caused by delayed clinical and laboratorial diagnosis, and probably also due to inadequate antituberculous drugs administration.