Arora Nimisha, Saha Abhijeet, Kaur Manpreet
a Division of Pediatric Nephrology, Department of Pediatrics , Lady Hardinge Medical College and Associated Kalawati Saran Children Hospital , New Delhi , India.
b Division of Pediatric Nephrology, Department of Pediatrics , Postgraduate Institute of Medical Education & Research and Associated Dr. Ram Manohar Lohia Hospital , New Delhi , India.
Paediatr Int Child Health. 2017 Nov;37(4):292-297. doi: 10.1080/20469047.2017.1386847. Epub 2017 Nov 1.
Tuberculous pyelonephritis is rare in children; three case reports are presented. Case 1 was an 11-year-old girl with a previous history of pulmonary tuberculosis who presented with flank pain and fever for 10 days. An ultrasound suggested focal pyelonephritis, and a contrast-enhanced computed tomography (CECT) scan demonstrated acute focal pyelonephritis and a perinephric collection. Mycobacterium tuberculosis was cultured in the urine. She responded well to anti-tuberculous treatment (ATT). Case 2 was a 13-year-old boy who presented with fever, haematuria, burning micturition, proteinuria (3+) and cervical lymphadenopathy. The Mantoux test was strongly positive. Chest radiograph demonstrated right hilar lymphadenopathy and ultrasonography showed evidence of acute pyelonephritis. Tuberculous lymphadenitis was diagnosed by fine-needle aspiration cytology (FNAC) from cervical lymph nodes and he responded to ATT. Follow-up urinalysis and ultrasound were normal. Case 3 was a 6-year-old boy, a known case of pulmonary tuberculosis (from 2 years of age) and a previous defaulter from ATT. He presented with symptoms of lumbar pain and dysuria. Chest radiograph demonstrated mediastinal lymphadenopathy and a CECT of the head showed a tuberculous granuloma. CECT of the abdomen showed an enlarged left kidney with focal pyelonephritis, an abscess in the upper pole and parenchymal calcification. FNAC of the cervical lymph nodes supported a diagnosis of disseminated tuberculosis with tuberculous pyelonephritis. He was given 8 months of ATT. Fifteen months later he presented again with clinical and urinary findings of urinary tract infection. CECT now demonstrated gross hydronephrosis of the left kidney, and it was confirmed to be non-functioning by a DMSA scan and magnetic resonance urogram. Diethylenetriaminepentaacetic acid showed a GFR of 44.3 ml/min/1.73 m. Nephrectomy was undertaken and the histology confirmed tuberculous pyelonephritis. Six months later he was well with an eGFR of 87.2 ml/min/m. In patients with symptoms of urinary tract infection but sterile urine who do not respond to antibiotics or have evidence of tuberculous elsewhere in the body, careful consideration should be given to the possibility of tuberculous pyelonephritis.
结核性肾盂肾炎在儿童中较为罕见；本文报告了3例病例。病例1为一名11岁女孩，既往有肺结核病史，出现侧腹痛和发热10天。超声提示局灶性肾盂肾炎，增强计算机断层扫描（CECT）显示急性局灶性肾盂肾炎和肾周积液。尿液培养出结核分枝杆菌。她对抗结核治疗（ATT）反应良好。病例2为一名13岁男孩，表现为发热、血尿、尿痛、蛋白尿（3+）和颈部淋巴结肿大。结核菌素试验强阳性。胸部X线片显示右肺门淋巴结肿大，超声检查显示急性肾盂肾炎迹象。通过颈部淋巴结细针穿刺细胞学检查（FNAC）诊断为结核性淋巴结炎，他对ATT有反应。随访尿常规和超声检查均正常。病例3为一名6岁男孩，已知患有肺结核（自2岁起），既往曾中断ATT治疗。他出现腰痛和排尿困难症状。胸部X线片显示纵隔淋巴结肿大，头部CECT显示结核性肉芽肿。腹部CECT显示左肾增大，伴有局灶性肾盂肾炎、上极脓肿和实质钙化。颈部淋巴结FNAC支持播散性结核合并结核性肾盂肾炎的诊断。他接受了8个月的ATT治疗。15个月后，他再次出现尿路感染的临床和尿液检查结果。CECT现在显示左肾严重肾积水，通过二巯基丁二酸扫描和磁共振尿路造影证实该肾无功能。二乙三胺五乙酸显示肾小球滤过率为44.3 ml/min/1.73 m²。进行了肾切除术，组织学检查证实为结核性肾盂肾炎。6个月后，他情况良好，估算肾小球滤过率为87.2 ml/min/m²。对于有尿路感染症状但尿液无菌且对抗生素无反应或体内其他部位有结核证据的患者，应仔细考虑结核性肾盂肾炎的可能性。
