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IF 0.6 Q4 SURGERY

International Journal of Surgery Case Reports Pub Date : 2025-04-07 DOI:10.1016/j.ijscr.2025.111278

Suthir Balan Nadar , A. Farook , A. Balaji , R. Karunanithi

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引用次数: 0

摘要

导言结核性肾盂积水约占肺外结核病的 15-20%。通常情况下，小病灶进入肾实质后会因细胞介导的免疫而被阻断，但随后可能出现反应性疾病。本研究显示了一例罕见的多囊肾病例，患者无症状，但经 DTPA 肾图扫描发现左肾功能不全，由于肾脏和肾门有严重的炎症改变，患者接受了肾切除术。病例介绍一名 31 岁的女性患者主诉其脐部肿胀已持续 2 个月，无其他泌尿生殖系统不适或发热，也未接触过任何肺结核病例。临床讨论患者因上述主诉前来就诊，计划进行腹部 CT 检查，结果发现患者患有病因不明的多囊肾，接着进行了 DTPA 肾图扫描，发现左肾灌注率为 7.95%。随后计划进行肾脏切除术，术中显示为结核性肾脏。结论结核性肾盂积水可能是一种罕见的无症状多囊肾。

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A case report of asymptomatic tuberculous pyonephrosis of the left kidney that presented as a polycystic kidney with piece meal nephrectomy

Introduction

Tuberculous pyonephrosis accounts for about 15–20 % of extrapulmonary TB. Often small foci that travel to the renal parenchyma get arrested due to cell mediated immunity, but reactive disease may develop later. Caseous lesions may develop in the kidney leading to necrosis in renal parenchyma affecting the functioning of the kidney leading to chronic renal failure.

Importance

The study shows a rare case of a polycystic presentation of the kidney in which the patient was asymptomatic with a non-functioning left kidney identified by DTPA Renogram scan and was proceeded with nephrectomy which was done in piece meal manner owing to the severe inflammatory changes in the kidney and renal hilum.

Case presentation

A 31-year-old female patient presented with complaints of swelling in the umbilical region for last 2 months with no other genitourinary complaints or fever or contact with any TB cases. On inspection the abdomen was lax with a 2*2 umbilical swelling non tender and reducible, no renal angle fullness.

Clinical discussion

Patient presented with above mention complaints and was planned for CT Abdomen in which patient found to have a polycystic kidney of unknown etiology, patient the proceeded with DTPA Renogram scan found to have 7.95 % perfusion in the left kidney. Subsequently planned for nephrectomy which intraoperatively presented as a tuberculous kidney. And proceeded with piece meal nephrectomy.