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). The CT positivity rate in the typical group was higher than that in the atypical group (P 0.05), both of which were higher than those of acid-fast staining and TB culture (P 0.05), and both were higher than that of 16KDa antibodies (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.