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abstract

373 - RENAL TUBERCULOSIS: AN UNUSUAL CAUSE OF URINARY SYMPTOMS IN ADOLESCENT GIRLS

373

RENAL TUBERCULOSIS: AN UNUSUAL CAUSEOF URINARY SYMPTOMS IN ADOLESCENT GIRLS

S. SHARMA, V. P. MYNEEDU, P.SHARMA;
PEDIATRICS, Natl. Inst. of TB & Respiratory Diseases,New Delhi, India.

Introduction: Tuberculosis is acommon disease especially in developing countries. Though pulmonarytuberculosis (PTB) is commonest, extra-pulmonary TB (EPTB) is alsobecoming common. However involvement of kidneys in TB is rare. Wepresent 2 cases with renal involvement and urinarysymptoms.
Objective: 1. To assess the renal involvement ingirls with pulmonary TB and extra-pulmonary TB 2. To assess theurinary symptoms in girls with pulmonary TB and extra-pulmonaryTB
Methods: A total of 100 girls {62 (66.7%) with pulmonaryTB cases and 38 (33.3%) with extra-pulmonary TB cases} were studiedover a 2 year period for renal involvement. Detailed history wastaken from all patients Examination (general physical, chest andabdominal) was performed in all cases. The patients were investigatedby sputum smear and CBNAAT examination, X-ray chest, fine needleaspiration from the EPTB site. Ultrasound, CECT were done in selectedcases for demonstration of TB lesions in abdomen. HIV testing wasdone in all patients after taking informed consent. All girls weretreated with first line anti-tubercular drugs, rifampicin (R),isoniazid (H), pyrazinamide (Z), ethambutol (E), with or withoutstreptomycin (S) under WHO based regimens of using alternate dayintermittent directly observed treatment short-course (DOTS). 6months therapy with 2 months of intensive phase and 4 months ofcontinuation phase ie. 2R3H3Z3E3/4R3H3for new patients and 8 months therapy 3 months of intensive phase and5 months of continuation phase 2S3R3H3Z3E3/1R3H3Z3E3/5R3H3E3for cases requiring retreatment.
Results: The involvementof kidney was seen in only 2 cases, with 1 case each of pulmonary andextrapulmonary TB. Both girls were HIV negative. The case ofpulmonary TB had urinary frequency and urgency, associated withsterile pyuria (repeated negative pyogenic cultures of urine) but hadpositive culture for AFB. Patient responded to Category 1 ATT.Another patient with mediastinal lymph nodes on Category 1 ATT hadpersistence of fever, worsening cough with shortness of breath, painabdomen, 2 episodes of hematuria, frequency of micturition andurgency even after 2 months of Category 1 under direct observation..CECT abdomen showed multiple splenic and a renal abscesses withmultiple enlarged necrotic mesenteric lymph nodes. Fine needleaspiration from renal abscess showed acid fast bacilli resistance toboth Rifampicin and Isoniazid i.e MDR TB. The patient was started onCategory 4 treatment regimen of WHO under DOTS Plus (6 months ofKanamycin, Ethionamide, Levofloxacin, Pyrazinamide, Cycloserine andEthambutol in the Intensive Phase followed by 4 drugs in the 18months of Continuation Phase. The patient responded well with herurinary symptoms and abdominal pain disappearing by 4th month
Conclusions: Renal TB should be kept in mind inpatients of pulmonary and extrapulmonary TB with urinary symptoms. Incase of no or delayed response to 1st line antituberculardrugs, fine needle aspiration should be performed to rule out drugresistant TB.
References: 1. Rapid Advice: Treatment oftuberculosis in children WHO/HTM/TB/2010.13 2. Guidance for nationaltuberculosis programmes on the management of tuberculosis in childrenWHO/HTM/ TB/2006.371