Kulchavenya E V, Kholtobin D P, Brizhatyuk E V
Tuberculosis Research Institute of Minzdrav of Russia.
Novosibirsk State Medical University of Minzdrav of Russia, Novosibirsk, Russia.
Urologiia. 2018 Mar(1):48-52.
Urolithiasis and nephrotuberculosis, due to the similarity of the radiographic patterns, share the same differential diagnosis list. The study aimed to analyze the incidence of co-occurrence of nephrotuberculosis and urolithiasis and to determine the impact of urolithiasis on the clinical course of renal tuberculosis.
This open cohort retrospective study comprised 843 patients with renal tuberculosis and 245 patients with urolithiasis. 1088 medical records were analyzed to identify cases with co-occurrence of these two diseases and determine the clinical presentation of renal tuberculosis, urolithiasis, and the comorbid state. Also, patients with pulmonary tuberculosis (44), urogenital tuberculosis (17), and chronic nonspecific pyelonephritis (12) were tested for serum concentration of total calcium and phosphorus.
Of 843 patients with renal tuberculosis, 39 (4.6%), had concomitant nephrolithiasis. The combination of urolithiasis with nephrotuberculosis manifested by more severe symptoms; these patients had a more than two-fold risk of tuberculosis recurrence. Except for the incidence of renal colic and dysuria, the clinical manifestations of urolithiasis and nephrotuberculosis did not differ statistically significantly. Prolonged infectious and inflammatory process in the kidneys resulted in an increase in the excretion of oxalates, which was more pronounced in patients with nonspecific pyelonephritis (p<0.05). A three-month course of antituberculosis chemotherapy resulted in a 36.2% increase in the excretion of oxalates in patients with urotuberculosis (p<0.05). Excretion of uric acid also significantly increased after a three-month intake of antituberculosis drugs.
In our study, the incidence of concomitant urolithiasis and urogenital tuberculosis was low (4.6%), but comorbidity significantly complicated the clinical course of the disease and worsened the prognosis of nephrotuberculosis. Antituberculosis polychemotherapy increases the risk for formation of urinary stones. Prevention of urolithiasis in patients with urogenital tuberculosis warrants further investigation.
由于放射影像学表现相似，尿路结石和肾结核具有相同的鉴别诊断清单。本研究旨在分析肾结核和尿路结石同时存在的发生率，并确定尿路结石对肾结核临床病程的影响。
这项开放性队列回顾性研究包括843例肾结核患者和245例尿路结石患者。分析了1088份病历，以确定这两种疾病同时存在的病例，并确定肾结核、尿路结石和合并状态的临床表现。此外，对44例肺结核患者、17例泌尿生殖系统结核患者和12例慢性非特异性肾盂肾炎患者进行了血清总钙和磷浓度检测。
在843例肾结核患者中，39例（4.6%）合并有肾结石。尿路结石与肾结核合并存在时症状更严重；这些患者结核复发风险增加两倍多。除肾绞痛和排尿困难发生率外，尿路结石和肾结核的临床表现无统计学显著差异。肾脏中长期的感染和炎症过程导致草酸盐排泄增加，在非特异性肾盂肾炎患者中更为明显（p<0.05）。抗结核化疗三个月疗程使尿路结核患者草酸盐排泄增加36.2%（p<0.05）。服用抗结核药物三个月后尿酸排泄也显著增加。
在我们的研究中，尿路结石与泌尿生殖系统结核同时存在的发生率较低（4.6%），但合并症显著使疾病临床病程复杂化，并使肾结核预后恶化。抗结核联合化疗增加了尿路结石形成的风险。泌尿生殖系统结核患者尿路结石的预防值得进一步研究。
