Case Report: A case of advanced renal tuberculosis with recurrent “kidney stones” and specific pathological manifestations

Background Renal tuberculosis is a chronic granulomatous, infectious kidney disease caused by tuberculosis infection, often leading to ureteral tuberculosis, bladder tuberculosis, prostate tuberculosis and genital tract tuberculosis. Its typical pathologic changes are tuberculous nodule formation accompanied by different degrees of caseous necrosis. In recent years, the incidence of atypical renal tuberculosis has increased significantly, with extremely high rates of misdiagnosis and missed diagnosis. Prolonged delays in diagnosis and treatment have led to severe consequences such as renal failure, warranting high priority attention. Even in cases of early-diagnosed renal tuberculosis that achieve “clinical cure” following standardized, full-course anti-tuberculosis drug treatment, some patients still experience severe or even complete renal impairment. Pathological diagnosis can be used to confirm renal tuberculosis. However, what is the pathological outcome after prolonged anti-tuberculosis drug treatment? Does renal tuberculosis complicated by other kidney diseases exhibit specific pathological manifestations? Why does renal function loss occur despite achieving clinical cure? This case report provides answers to these questions. Case presentation A 58-year-old female patient with advanced renal tuberculosis was performed nephrectomy ultimately due to loss of renal function even after 4 years of anti-tuberculosis drug treatment. During the treatment for left renal tuberculosis, the patient experienced recurrent left renal calculi and underwent three ureteroscopic lithotripsy procedures along with ureteral stent placement for hydronephrosis drainage. Postoperative pathological changes revealed chronic nephritis, extensive tubular atrophy, glomerulosclerosis, accompanied by renal abscesses and cyst formation. However, given the positive Mycobacterium tuberculosis culture 4 years ago, combined with CT imaging findings and a positive T-SPOT.TB test, renal tuberculosis was definitively diagnosed based on positive GeneXpert and TB-DNA PCR results from renal tissue samples, which suggests that Mycobacterium tuberculosis persists in the renal tissue despite 4 years of antituberculosis treatment. Conclusion Renal tuberculosis complicated by recurrent kidney stones and hydronephrosis, along with suspected urinary tract infection, can lead to atypical pathological changes in renal tissue and exacerbate renal dysfunction. TB-DNA PCR and GeneXpert testing of renal tissue aid in establishing a pathogenetic diagnosis, thereby enhancing the efficacy of pathological diagnosis for renal tuberculosis. Alongside effective, full-course anti-tuberculosis drug therapy and adequate renal pelvic drainage, timely treatment of comorbidities such as renal calculi and urinary tract infections is essential.