Isolated renal tuberculosis presenting as staghorn calculi and hydronephrosis – a case report and literature review

Abstract

Introduction and importance: TB, a major health concern caused by Mycobacterium tuberculosis, primarily affects the lungs but can also manifest as extrapulmonary TB (EPTB). Genitourinary tuberculosis (GUTB) ranks third among extrapulmonary TB cases, following lymphatic and pleural involvement. Case presentation: A 45-year-old female from Amahra, Ethiopia presented with long-standing flank pain, constitutional symptoms, and lower urinary tract symptoms. She had no significant comorbidities. Physical examination was unremarkable except for left costovertebral angle tenderness. Abdominal imaging revealed normal renal parenchyma, left hydronephrosis, and a staghorn calculus. A unilateral nephrectomy was performed, and surprisingly, pathological analysis suggested renal tuberculosis. The patient was subsequently treated with a 6-month course of antituberculosis therapy. Case discussion: Isolated renal tuberculosis (RTB) is a rare and often difficult-to-diagnose form of TB due to its nonspecific symptoms. Presentations range from asymptomatic to severe, including complications like staghorn calculi or masses. Rena; TB, while typically associated with certain risk factors, can occur even in their absence, as in this case where the patient only resided in a high TB burden area. Mycobacterium tuberculosis usually reaches the kidneys via hematogenous spread from the lungs, though direct spread is also possible, but isolated renal involvement is rare. Diagnosis of isolated renal tuberculosis is challenging, often requiring histopathology after nephrectomy or biopsy, as urine cultures may be unrevealing. Imaging findings vary with the disease stage, with CT best for calcifications and CT IVP offering broader sensitivity. Treatment involves anti-tuberculosis medications guided by WHO and national guidelines. While medications are often sufficient, advanced cases may require surgical interventions like nephrectomy, with the choice dependent on factors like disease extent and renal function. Conclusion: Isolated renal tuberculosis (RTB) is rare and can be difficult to diagnose due to its varied symptoms Early detection and treatment with anti-TB drugs are key to preventing irreversible kidney damage and nephrectomy.