title: End-stage renal disease due to delayed diagnosis of renal tuberculosis: a fatal case report.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Medicine School, Federal University of Ceará, Fortaleza, CE, Brazil. ef.daher@uol.com.br
authors.forename: Elizabeth De Francesco
authors.initials: Ede F
authors.lastname: Daher
authors.forename: Geraldo Bezerra da
authors.initials: GB
authors.lastname: Silva Júnior
authors.forename: Renata Trindade
authors.initials: RT
authors.lastname: Damasceno
authors.forename: Gustavo Martins Dos
authors.initials: GM
authors.lastname: Santos
authors.forename: Germana Alves
authors.initials: GA
authors.lastname: Corsino
authors.forename: Sônia Leite da
authors.initials: SL
authors.lastname: Silva
authors.forename: Oswaldo Augusto
authors.initials: OA
authors.lastname: Gutiérrez-Adrianzén
mesh_terms: D000328:Adult; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014398:Tuberculosis, Renal / Q000150:complications* / Q000175:diagnosis