Analysis of the onset characteristics and diagnosis of 217 cases of renal tuberculosis.

Objectives: To explore the latest characteristics and diagnostic methods of renal tuberculosis, and to improve the new recognition and diagnostic level of renal tuberculosis.

Methods: We collected the medical records and postoperative histopathological slides of 217 patients diagnosed and treated with renal tuberculosis in the Department of Urology of Hebei Provincial Chest Hospital from March 25, 2013 to February 6, 2024, and divided them into the typical group (145 cases) and the atypical group (72 cases) according to their onset characteristics, and analyzed the distribution of onset symptoms and the differences in the positive rates of different examination methods between these two groups.

Results: (1) Frequency, urgency and pain of urination were the main symptoms in the typical group (66.82%), and local or systemic atypical symptoms in the atypical group (33.18%), and the incidence rate of women in the atypical group was higher than that in the typical group (P < 0.05). (2) In both groups, the positive rate of CT diagnosis of renal tuberculosis was higher than that of ultrasound and urography (P < 0.05), and there was no statistically significant difference between the positive rates of T-SPOT.TB and PPD tests (P > 0.05). The CT positivity rate in the typical group was higher than that in the atypical group (P < 0.05). In the typical group GeneXpert MTB/RIF had a higher positive rate than that of PCR TB-DNA, acid-fast staining and tuberculosis culture (P < 0.05). However, in the atypical group and all patients in both groups, there was no statistical difference between the positivity rates of GeneXpert MTB/RIF and PCR TB-DNA (P > 0.05), both of which were higher than those of acid-fast staining and TB culture (P < 0.05). The positivity rate of acid-fast staining and tuberculosis culture was higher in the typical group than that in the atypical group (P < 0.05). In the typical group, the positivity rate of LAM antibody was higher than that of 38KDa and 16KDa (P < 0.05). However, in the atypical group, there was no statistically significant difference between the positivity rates of 38KDa and LAM antibodies (P > 0.05), and both were higher than that of 16KDa antibodies (P < 0.05). (3) There was no significant difference in pathological changes between the two groups, both of which were dominated by granulomas and caseous necrosis, and the positivity of tissue PCR TB-DNA was higher than that of antacid staining (P < 0.05), but there was no statistically significant difference in the positivity of tissue PCR TB-DNA between the two groups (P > 0.05). Cystoscopic biopsy was dominated by granuloma and necrosis in the typical group and chronic inflammation in the atypical group.

Conclusions: (1) In addition to renal tuberculosis with bladder irritation as the main clinical manifestation, atypical renal tuberculosis is also an important part of renal tuberculosis, which is characterized by systemic or local atypical symptoms, and should be highly concerned. (2) CT, GeneXpert MTB/RIF, T-SPOT.TB (or PPD test) and LAM antibody have higher sensitivity both in typical and atypical renal tuberculosis, which can improve the diagnosis rate of renal tuberculosis. (3) There is no significant difference in the pathologic changes between typical and atypical renal tuberculosis, and PCR TB-DNA of the tissues may help to improve the pathologic diagnosis of renal tuberculosis. In atypical renal tuberculosis, bladder mucosal lesions are characterized by chronic inflammation, and cystoscopic biopsy alone is of low diagnostic value.