title: Urinary tuberculosis: a cohort of 79 adult cases.
abstract: We aimed to investigate the demographic, clinical, diagnostic, treatment and outcome features of patients with urinary tuberculosis (UTB). Patients with UTB admitted to seven separate centers across Turkey between 1995 and 2013 were retrospectively evaluated. The diagnosis of UTB was made by the presence of any clinical finding plus positivity of one of the following: (1) acid-fast bacilli (AFB) in urine, (2) isolation of Mycobacterium tuberculosis, (3) polymerase chain reaction (PCR) for M. tuberculosis, (4) histopathological evidence for TB. Seventy-nine patients (49.36% male, mean age 50.1 ± 17.4 years) were included. Mean time between onset of symptoms and clinical diagnosis was 9.7 ± 8.9 months. The most common signs and symptoms were hematuria (79.7%), sterile pyuria (67.1%), dysuria (51.9%), weakness (51.9%), fever (43%) and costovertebral tenderness (38%). Cystoscopy was performed in 59 (74.6%), bladder biopsy in 18 (22.8%), kidney biopsy in 1 (1.26%) and nephrectomy in 12 (15.2%) patients. Histopathological verification of UTB was achieved in 12 (63.1%) patients who undergone biopsy and in 100% of those undergone nephrectomy. Mycobacterium tuberculosis was isolated in the urine of 50 (63.3%) cases. Four-drug standard anti-TB treatment was the preferred regimen for 87.3% of the patients. Mean treatment duration was 10.5 ± 2.7 months. Deterioration of renal function occurred in 15 (18.9%) patients two of whom progressed to end-stage renal disease and received hemodialysis. Only one patient died after 74-day medical treatment period. Cases with UTB may present with non-specific clinical features. All diagnostic studies including radiology, cyctoscopy and histopathology are of great importance to exclude UTB and prevent renal failure.
authors.affiliation: a Department of Internal Medicine, Division of Nephrology , Cerrahpasa Medical School, Istanbul University , Istanbul , Turkey .
authors.forename: Mehmet Riza
authors.initials: MR
authors.lastname: Altiparmak
authors.affiliation: a Department of Internal Medicine, Division of Nephrology , Cerrahpasa Medical School, Istanbul University , Istanbul , Turkey .
authors.forename: Sinan
authors.initials: S
authors.lastname: Trabulus
authors.affiliation: b Department of Infectious Diseases , Cerrahpasa Medical School, Istanbul University , Istanbul , Turkey .
authors.forename: Ilker Inanc
authors.initials: II
authors.lastname: Balkan
authors.affiliation: a Department of Internal Medicine, Division of Nephrology , Cerrahpasa Medical School, Istanbul University , Istanbul , Turkey .
authors.forename: Serkan Feyyaz
authors.initials: SF
authors.lastname: Yalin
authors.affiliation: c Department of Internal Medicine, Division of Nephrology , Haydarpasa Training and Research Hospital , Istanbul , Turkey .
authors.forename: Nazim
authors.initials: N
authors.lastname: Denizli
authors.affiliation: d Department of Clinical Microbiology, Medical Faculty , Mersin University , Mersin , Turkey .
authors.forename: Gonul
authors.initials: G
authors.lastname: Aslan
authors.affiliation: e Department of Urology, Medical Faculty , Mersin University , Mersin , Turkey .
authors.forename: Hasan Erdal
authors.initials: HE
authors.lastname: Doruk
authors.affiliation: f Department of Infectious Diseases, Medical Faculty , Cumhuriyet University , Sivas , Turkey .
authors.forename: Aynur
authors.initials: A
authors.lastname: Engin
authors.affiliation: g Department of Infectious Diseases, Medical Faculty , Dicle University , Diyarbakir , Turkey .
authors.forename: Recep
authors.initials: R
authors.lastname: Tekin
authors.affiliation: h Department of Infectious Diseases, Medical Faculty , Ankara University , Ankara , Turkey .
authors.forename: Serhat
authors.initials: S
authors.lastname: Birengel
authors.affiliation: i Department of Infectious Diseases, Medical Faculty , Koc University , Istanbul , Turkey .
authors.forename: Birsen Durmaz
authors.initials: BD
authors.lastname: Cetin
authors.affiliation: j Department of Internal Medicine, Division of Infectious Diseases, Medical Faculty , Medipol University , Istanbul , Turkey , and.
authors.forename: Ferhat
authors.initials: F
authors.lastname: Arslan
authors.affiliation: k GATA Haydarpasa Training and Research Hospital , Istanbul , Turkey.
authors.forename: Vedat
authors.initials: V
authors.lastname: Turhan
authors.affiliation: j Department of Internal Medicine, Division of Infectious Diseases, Medical Faculty , Medipol University , Istanbul , Turkey , and.
authors.forename: Ali
authors.initials: A
authors.lastname: Mert
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D003558:Cystoscopy; D053159:Dysuria / Q000652:urine; D005260:Female; D006417:Hematuria / Q000652:urine; D006801:Humans; D007668:Kidney / Q000473:pathology* / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D009392:Nephrectomy / Q000379:methods; D016133:Polymerase Chain Reaction; D011776:Pyuria / Q000652:urine; D006435:Renal Dialysis / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D014398:Tuberculosis, Renal / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D014421:Turkey
keywords: Cystoscopy; epidemiology; renal failure; treatment; urinary tuberculosis