Dual burden of renal tuberculosis and renal stones: a diagnostic dilemma

Abstract

Objective: To review concurrent renal tuberculosis and nephrolithiasis as a diagnostic dilemma in clinical practice.

Method: The descriptive, prospective follow-up study was conducted at the Department of Urology, Sindh Institute of Urology and Transplantation, Sukkur, Pakistan, from May 2024 to February 2025, and comprised a retrospectively identified cohort from January 2020 to April 2024 of patients aged 4-70 years who had undergone nephrectomies and were subsequently found to have renal tuberculosis on histopathology reports compared to the initial diagnosis of non-functioning kidneys secondary to nephrolithiasis. . Data was analysed using SPSS 27.

Results: Of the 394 patients who underwent nephrectomies, 61(15.5%) were later identified as having renal tuberculosis; 34(55.7%) males and 27(44.6%) females with overall mean age 29.5±17 years. Profound risk factors included family history of tuberculosis 15(24.9%), malnutrition 33(54%), chronic renal failure 2(3.2%) and overcrowding 41(67.2%). Symptoms included frequency 19(29.5%), nocturia 11(18%) and fever 14(23%). Nephrocutaneous fistula was found in 7(12.9%) cases.  Calculi with perinephric collection were identified in 33(54.1%) cases, and calculi with hydronephrosis in 28(45.9%).

Conclusion: The dilemma in diagnosing renal tuberculosis in the presence of urolithiasis was likely due to the masking of classical tuberculosis symptoms, particularly in endemic regions.

Key Words: Renal tuberculosis, Nephrolithiasis, Malnutrition, Risk factors.