Am. J. Trop. Med. Hyg., 84(6), 2011, pp. 843–844
Copyright © 2011 by The American Society of Tropical Medicine and Hygiene
A 20-year-old man was admitted with fever, chills, dry cough,
right flank pain, and oliguria. Physical examination showed
a palpable mass in the right flank. Laboratory analysis was
notable for a creatinine clearance = 59 mL/min per 1.73 m 2 .
Tuberculin skin test was 8 mm; human immunodeficiency virus
(HIV) serology was negative. Urinalysis showed sterile pyu-
ria, but microscopy showed acid fast bacilli . The plain abdomi-
nal X-ray film showed silence of the right kidney ( Figure 1 ).
Images in Clinical Tropical Medicine
Tuberculosis-Associated Chronic Kidney Disease
Jobson Lopes de Oliveira , Geraldo Bezerra da Silva Junior , and Elizabeth De Francesco Daher *
Division of Nephrology, Department of Internal Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil;
School of Medicine, University of Fortaleza, Fortaleza, Ceará, Brazil
Abstract. Extrapulmonary tuberculosis (TB) account for approximately 15–20% of TB cases in immunocompetent
patients. The genitourinary system is the third most commonly affected site. We report the case of a 20-year-old man
admitted with fever, chills, dry cough, right flank pain, and oliguria who developed renal function loss. The pyelogram evi-
denced silence of the right kidney, and the abdominal and pelvic magnetic resonance showed significant dilation of the
right pyelocaliceal system and proximal ureter. Biopsies of renal cortex and retroperitoneal lymph nodes showed caseous
granuloma consistent with TB. Treatment was started with rifampicin, isoniazid, pyrazinamide, and ethambutol, and the
patient presented a favorable outcome but with non-dialytic chronic kidney disease. This case illustrates a case of chronic
kidney disease secondary to TB in a young, otherwise healthy man.
* Address correspondence to Elizabeth De Francesco Daher, Rua
Vicente Linhares, 1198 Fortaleza, CE, CEP 60270-135, Brazil.
E-mails: firstname.lastname@example.org or email@example.com
Figure 1. Pyelogram showing right kidney silence.
Figure 2. Chest X-ray showing small nodules scattered in the right
Figure 3. Nuclear magnetic resonance showing severe dilation of
right pyelocaliceal system and proximal ureter.
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OLIVEIRA AND OTHERS
The chest X-ray showed a fibrocavity infiltrate with small
nodules in the right upper lung ( Figure 2 ). The abdominal and
pelvic magnetic resonance showed significant dilation of the
right pyelocaliceal system and proximal ureter, with thicken-
ing of its middle one-third and amorphous retroperitoneal
images in the pericaval space with maximum measures of
2.5 × 8.5 cm, consistent with grouped lymph nodes ( Figure 3 ).
Biopsies of the renal cortex and retroperitoneal lymph nodes
showed caseous granulomas consistent with tuberculosis (TB).
Treatment was started with rifampicin, isoniazid, pyrazinamide,
and ethambutol, and the patient was left with chronic kidney
disease (creatinine clearance after TB treatment = 61 mL/min
per 1.73 m 2 ). The genitourinary system is often affected in TB
resulting from hematogenous spread from primary pulmo-
nary TB. 1 Urogenital TB is suspected particularly with sterile
pyuria. 2, 3 Renal dysfunction may result from direct infection
of the kidney parenchyma orureteral obstruction with resul-
Received January 6, 2011. Accepted for publication February 6, 2011.
Authors’ addresses: Jobson Lopes de Oliveira and Elizabeth De
Francesco Daher, Division of Nephrology, Department of Internal
Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil,
E-mails: firstname.lastname@example.org and email@example.com . Geraldo
Bezerra da Silva Junior, Division of Nephrology, Department of
Internal Medicine, Federal University of Ceará and School of
Medicine, University of Fortaleza, Fortaleza, Ceará, Brazil , E-mail:
1. Wise GJ , Merella VK , 2003 . Genitourinary manifestations of
tuberculosis . Urol Clin North Am 30: 111 – 121 .
2. Eastwood JB , Corbishley CM , Grange JM , 2001 . Tuberculosis and
the kidney . J Am Soc Nephrol 12: 1307 – 1314 .
3. Daher EF , Silva Júnior GB , Damasceno RT , Santos GM , Corsino
GA , Silva SL , Gutierrez-Adrianzen OA , 2007 . End-stage renal
disease due to delayed diagnosis of renal tuberculosis: a fatal
case report . Braz J Infect Dis 11: 169 – 171 .