Pediatric renal tuberculosis

Introduction to Kidney Tuberculosis in Children Tuberculosis of kidney refers to the secondary infection caused by Mycobacterium tuberculosis from the lungs or other organs of tuberculosis, disseminated to the kidneys by blood. The disease is slow, no obvious symptoms in the early stage, and severe cases of refractory urinary tract irritation as the main clinical manifestations, more common in young people aged 20 to 40 years old, more male than female, kidney tuberculosis is urinary system and male reproductive system tuberculosis The initial onset, tuberculosis can gradually spread from the kidney to the ureter, bladder and urethra, urine containing tuberculosis, spread to the reproductive system through the urethra, ejaculatory duct and prostate tube. basic knowledge The proportion of illness: 0.001% Susceptible people: children Mode of infection: non-infectious Complications: urinary incontinence Uremia Hypertension

Pediatric tuberculosis cause

Cause:

The main primary lesion of renal tuberculosis is tuberculosis, and a small number of tuberculosis lesions from bones, joints, intestines, and lymph nodes occasionally spread from the reproductive tract to the kidneys.

1. Common pathogens: The most common pathogen of this disease is human M. tuberculosis.

2. Uncommon pathogens: Other rare pathogens include Mycobacterium tuberculosis and Mycobacterium.

Pathogenesis:

The main primary lesion of renal tuberculosis is tuberculosis. A few tuberculosis lesions from bone, joint, intestine, and lymph nodes occasionally spread from the reproductive tract to the kidney. The basic pathological changes of tuberculosis in the kidney are tuberculous nodules or tuberculous granuloma formation. The center of tuberculosis nodules is caseous necrotic tissue surrounded by epithelial cells and giant cells of laugharis. The periphery is lymphocytes and fibrous tissue. Mycobacterium tuberculosis invades the kidneys through blood channels, first in the glomerular capillary plexus of bilateral kidneys. The formation of microtuberculosis lesions (pathological renal tuberculosis), in the case of normal body resistance, microtuberculosis lesions can be cured or long-term quiescent, no clinical symptoms, but unhealed microtuberculosis lesions can cause tuberculosis urine, early The lesion is a glomerular tuberculous nodule, which can develop necrotizing damage and spread to the small tube. Most cases are from insidence to re-activity for 10 to 40 years. Once the cheese-like necrosis is formed, it rarely occurs and heals. Necrotic papillitis to the formation of renal parenchyma, calcium deposition; infection continues to spread, renal pelvic inflammation to fibrosis, affecting the collection system, forming a narrow Narrow and hydronephrosis, if the actual fibrosis progresses, the renal blood vessels are narrow, cause fibrosis, and finally the kidney structure is destroyed. If it is "planted" into the urine, urethritis, cystitis (with ulceration, fibrosis and wall) may occur. Thicken).

Pediatric tuberculosis prevention

1. Vaccination with BCG to inoculate BCG in uninfected tuberculosis is a fundamental measure to prevent tuberculosis.

2. Active treatment to prevent spread If tuberculosis infection occurs, it should be actively treated to prevent the spread of the disease.

3. Strengthen nutrition and avoid overwork.

4. Prevention of Kidney Tuberculosis Most of the tuberculosis is from tuberculosis. If tuberculosis has been cured, although tuberculosis does not spread from the respiratory tract, it can still be transmitted from the urine. In order to prevent the infection of kidney tuberculosis, the following points should be noted:

(1) Special for the stool: The patient's stool should be used separately. The patient's urine should be added with the same amount of quicklime or appropriate amount of bleaching powder. After being placed for 1 hour, it should be poured to kill the tubercle bacilli in the urine.

(2) Special for scrubbing equipment: Patients should have special scrubbing equipment and should not share it with others.

(3) Separate room: It is better for the patient to have a separate room. At least one bed should be taken separately. The bedding should be exposed frequently, and the clothes should not be worn by the family.

Pediatric tuberculosis complications Complications, urinary incontinence, uremia, hypertension

Can be complicated by urinary incontinence, secondary bacterial infection, cold abscess can occur, uremia can occur, in addition, 5% to 10% of high blood pressure, may have seminal vesiculitis, epididymitis, 10% to 25% of patients with renal function Decrease.

Pediatric Kidney Tuberculosis Symptoms Common Symptoms Low Back Pain with Kidney Area Snoring Pain Urgency Aversion Urinary Frequent Pneumatic Urine Urine Pain Urine Blood Urine Appetite Decreased Proteinuria

Patients who have not entered the stage of clinical tuberculosis have no clinically significant symptoms, but urine tuberculosis can be positive. Patients with mild clinical tuberculosis may also have abnormal urine sediment. On the basis of tuberculosis, with pyuria and hematuria. And mild proteinuria.

1. Urinary tract irritation symptoms: frequent urination, urgency, urinary pain is a typical and prominent clinical symptom of renal tuberculosis, frequent urinary frequency, urinary frequency can not be accompanied by dysuria at the initial onset, application of general antibiotic treatment is invalid, serious patients can occur Urinary incontinence, difficulty urinating and nocturia, which is related to bladder involvement.

2. Hematuria: Kidney, ureter or bladder tuberculosis can cause hematuria, caused by tuberculous ulcer in the triangle of the bladder, mostly terminal hematuria, the majority of hematuria due to urinary vascular injury above the bladder.

3. Pyuria: There are a large number of pus cells under the microscope, sometimes necrotic tissue can be found, and the urine of a serious patient can be "rice-like".

4. Renal pain and mass: local symptoms of renal tuberculosis are not obvious, tenderness and renal lumps (water accumulation) are less common, tuberculous pus and kidney secondary infection (mostly Escherichia coli), or cold around the kidney Abscess may have local cramps and pain, and even the waist sinus, due to stones, clots, debris can cause urinary tract cramps.

5. Systemic symptoms: In severe cases or other organs, tuberculosis, fatigue, hot flashes, night sweats, loss of appetite are common, and uremia can occur in patients with severe renal impairment.

Pediatric tuberculosis examination

Laboratory inspection

1. Urine routine examination: About 90% of patients with renal tuberculosis have proteinuria, pyuria and hematuria. Aseptic pyuria should be highly suspected of renal tuberculosis in addition to urine routine, can be used for 24 hours concentrated urinary direct smear for acid-fast bacilli, check the standard laboratory positive rate of 70% health search but smodium bacillus, Bacillus subtilis Mycobacteria and the like are also acid-fast bacilli, therefore: (1) When leaving the urine, attention should be paid to the clean and healthy search in the vicinity of the urethral opening to avoid contamination. (2) The positive rate of acid-fast bacilli is not equal to tuberculosis.

2. Urine culture examination: About 90% of patients with M. tuberculosis urine culture positive. If the urinary tuberculosis culture is positive, the urinary system tuberculosis can be diagnosed. Antibiotics were stopped for 1 week before urinary tuberculosis culture, and immediate vaccination with morning urine increased the positive rate. The general growth of urine has the possibility that bacterial growth cannot rule out tuberculosis infection.

3. Blood test: Some patients have renal dysfunction.

Other auxiliary inspection

1. X-ray examination: 90% of patients with abnormal ICP and renal pelvis abnormalities, "worm-like" ulcers are initially small ulcers, and later developed into feathers, and finally communicate with the collecting duct system, visible funnel-shaped fibrous stenosis The ureter-pelvis junction has a scar that causes the renal pelvis to "cut off", causing hydronephrosis and automatic nephrectomy. The ureter is a strong bead-like or spiral-like cork, and the calcification of the renal pelvis and ureteral bladder tick indicates tuberculosis. The main manifestations of renal calcification and changes in kidney volume are often calcified in the unilateral renal cortex and medulla, and the renal calcification is self-cutting. At the time of diagnosis, attention should be paid to the difference between the renal nipple calcification caused by hyperparathyroidism and the positive stones located in the renal pelvis and renal pelvis. The kidneys can be enlarged and lobulated, unlike the expansion of the hydronephrosis. Intravenous or retrograde urography: only when the renal parenchyma is significantly damaged, the early changes can be expressed as a small sputum of the kidney, and the health of the worm-like edge is not neat, and the renal pelvis is irregularly enlarged. Scar contractors can reduce the appearance of renal pelvis defects in one or more small sputum. In the late stage, most of the renal pelvis damage can be seen as a plurality of irregularly shaped, varying sizes of voids. If the renal function is lost, the urinary tract angiography will not develop the kidney. Retrograde ureteroscopic angiography sometimes shows multiple hollow shadows in the kidney, but retrograde angiography is not successful when bladder tuberculosis is severe or ureteral stricture. X-ray of ureteral tuberculosis showed multiple stenosis or thick and thin stenosis in the lumen of the tube, and the lumen was stiff. Renal tuberculosis with significant renal dysfunction is generally not satisfactory for general dose intravenous urography. After high-dose intravenous urography, cavity lesions and ureteral stricture can clearly show that ureteropelvic or ureteral bladder can be observed under closed-circuit television. Dynamic changes in the connection. Therefore, retrograde pyelography has been greatly reduced, only used in the lower ureteral stricture and separately collected renal pelvis.

2. CT examination: CT can display an X-ray image of a cross section of the kidney, which is helpful for finding renal tuberculosis and helps with monitoring.

3. B-ultrasound: can help diagnose tuberculosis, hydronephrosis or renal calcification in the kidney.

4. Examination of cystoscopy: early manifestation of bladder mucosal edema, congestion, ulcers; granuloma and scar formation can be seen in the late stage, lesions near the ureteral opening and the bladder triangle are obvious, and the ureteral opening is narrow and cave-like. . Cystoscopy is not possible if the cystoscopy is less than 100 ml and the cystoscopy is less than 50 ml. When the inflammation is severely indistinguishable from the bladder carcinoma in situ, a biopsy is required. If you have a tuberculosis lesion and do a biopsy biopsy, you can confirm the diagnosis.

Diagnosis and diagnosis of renal tuberculosis in children

If there is a history of tuberculosis or a history of close contact with tuberculosis, those who have not been vaccinated with BCG are helpful in the diagnosis of this disease, combined with clinical manifestations to confirm the diagnosis.

Renal tuberculosis often needs to be differentiated from non-specific urinary tract infections, kidney tumors, and kidney stones.

1. Chronic pyelonephritis;

2. Kidney stones: When the kidney stones are still, only the kidney area is dull or asymptomatic. During the stone activity, it can cause renal colic and hematuria, but there is no urinary tract irritation of kidney tuberculosis. X-ray positive stones are located in the renal pelvis and renal pelvis. .

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