Pyelonephritis Due to Tuberculosis and Fungi

Written by docteam Monday, 17 May 2010 18:46

Infection of the kidney with Mycobacterium tuberculosis tends to produce chronic destructive lesions in the kidney. Characteristically there is marked distortion of the architecture of the pelvicaliceal system and an irregular configuration of the kidney. It is believed to be due to hematogenous spread of the organism during primary infection with reactivation of the disease many years later.

In the male, there is often concomitant infection of the bladder, prostate, epididymis and testicle. The first clinical manifestation of renal tuberculosis may be a nontender scrotal mass or obstruction at the ureteropelvic junction producing hydronephrosis. Tuberculosis often produces localized areas of ureteral inflammation and obstruction due to granuloma formation.

In the female, infection may also be present in the fallopian tube. Symptoms are usually insidious with general abdominal discomfort and nonspecific geniturinary complaints. Most patients with renal involvement also have active pulmonary or disseminated tuberculosis, but renal tuberculosis may be discovered in the absense of disease elsewhere. The tuberculin test is reported to be possitive in 85% of cases.

Mycobacterium kansasii may produce disseminated infection particularly in patients with pancytopenia. Two cases of renal involvement with granuloma have been attributed to this organism. It may be isolated from the urine and on renal biopsy.

Fungal infection of the kidney often mimics renal tuberculosis and chronic bacterial pyelonephritis. Many differet species including cyrptococcus, nocardia, actinomyces, aspergillus, blastomyces, coccidioidomyces, histoplasma, and mucor have been reported to produce prostatic, epididymal and renal infection.
Candida pyelonephritis is a major feature of disseminated disease in the immunocompromised host. The organis may be protected in part from leukocytes by growth in the renal tubular lumen. They then extend their pseudohyphae into the interstitium and produce multiple focal abscesses in the kidney.