Date post: | 08-Jun-2015 |
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Health & Medicine |
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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