Presentation
Renal dialysis patient presenting with increased temperatures for investigation of left kidney pyelonephritis.
Patient Data
Bilateral severe caliectasis without evidence of hydronephrosis.
Decreased corticomedullary differentiation with cortical thinning apparent bilaterally.
Large left sided renal cavity in communication with a blunted and atrophied calyceal system best seen on final video loop of kidney.
Small volume "thimble" bladder with a transurethral catheter in situ.
Additional findings of fluid overload include free fluid in the pelvis and a small right pleural effusion.
Case Discussion
Both kidneys tested positive for mycobacterium tuberculosis on renal biopsy, including a positive urine culture. The right kidney is known to be non-functional. The patient is also known with a thimble bladder. The patient is HIV-negative.
Renal TB reactivates after a long latency period and is predominantly seen in those over 20 years old 1.
TB spreads hematogenously to the renal cortex, which is thought to provide an ideal environment for granulomas due to its high oxygen content 2. TB mycobacteria flow down the nephrons and get trapped at the narrow loops of Henle, resulting in infection of the renal papillae 3. This causes sloughing due to inflammation 2. The renal parenchyma heals by fibrosis and stricture formation 2 leading to cortical thinning, parenchymal cavitation, blunted calyces, and caliectasis 1-3. Strictures of the pelvicalyceal system may progress due to the body’s recovery response despite treatment 3. Note that in this case, no hydronephrosis is seen.
Once the renal granulomas enter the upper collecting tract and pass distally, ureteric and bladder TB are also possible, resulting in a thimble bladder 2.
No secondary signs of pyelonephritis could definitively be identified.
Unable to process the form. Check for errors and try again.