Image of the week Jagdish K

Dr.Prof.A.Gowrishankar’s unit

HISTORY

• 55yr old male presented to the OPD for getting drugs for hypertension & routine follow up.

• Not a known DM.

• Known HT for 1yr on irregular treatment

• H/O TB when he was 35yrs old & completed ATT course.

• No other significant history.

EXAMINATION

• well oriented, conscious , afebrile.

• General examination was unremarkable

• Pulse : 80/min

• BP : 160/90 mm of hg

• Systems : normal

Contd…

• Patient had been worked up in a private hospital in Bangalore & few investigations were available with him.

• He presented to that hospital with abdominal pain 3 years back.

• KUB was ordered as he was provisionally diagnosed to have renal calculus

Close up view of X-ray KUB

IVU

PUTTY KIDNEY

• What is “putty” ?

• What does putty kidney mean? • How to diagnose it radiographically?

• What is autonephrectomy?

Other radiological features of renal TB

• moth-eaten appearance• phantom calix• hiked-up or purse-string appearance• sawtooth appearance• pipestem ureter• beaded or corkscrew ureter• thimble bladder

RENAL CALCIFICATIONSA. Dystrophic calcification due to localised disease:

Usually one kidney or part of one kidney. Infections :

1. Tuberculosis 2. Hydatid disease3. Xanthogranulomatous pyelonephritis4. Abscess

Carcinoma Aneurysm of renal artery

Contd . . .B. Nephrocalcinosis C. Medullary :

1. Hyperparathyroidism 2. RTA3. Medullary Sponge Kidney4. Renal papillary necrosis5. Causes of hypercalcemia or hypercalciuria6. Preterm infants7. Primary hyperoxaluria

D. Cortical :1. Acute cortical necrosis2. Chronic glomerulonephritis3. Chronic transplant rejection

GUTB• Clinical symptoms develop 10 to 15 years after

primary infection.

• Only about a quarter of the patient with genito urinary involvement have known history TB

• About half of these patients have a normal chest radiography findings

Symptoms of GUTB

• Increased frequency of urination

• Dysuria

• Flank pain

• Hematuria

• Unexplained infertility

• ASYMPTOMATIC presentation is not uncommon

INVESTIGATIONS• Tuberculin skin test

• CBC, ESR, CRP

• Serial early morning urine collection for AFB smear (atleast 3)

• Serial culture LJ media

• BACTEC 460 radiometric assay

• PCR

CONTD…

• Radiography

• IVU

Management

• ATT

• Nephrectomy?

THANK YOU