GUTB Role of Routine Nephrectomy for Non Functioning Kidneys

• 27 Jan 2021 08:21:21 AM
• |General Urology

Dear All,

We in India still take facts presented from Western Literature as regards GUTB as gospel truth. Our experience as regards GUTB is definitely far more than what has been documented but our problem is improper documentation. We have seen many more aspects of GUTB of varied nature. AIIMS will have to be complimented as most of the studies pertaining to GUTB in India have come from this centre. Many others have presented their experiences at conferences but have not published them.

I am sure there are many seniors among Indian Urologists with vast experience. If some of them could pen down their personal experience, probably we can rewrite what ought to be learned concerning GUTB.

I am providing an article from AIIMS, Delhi which addresses the need for Routine Nephrectomy for Non Functioning TB Kidney. I am hopeful that many would post their views based on this study so that we can further our knowledge.

Role of routine nephrectomy for non-functioning kidneys due to genitourinary tuberculosis: Data from an Indian subcontinent

Pradeep Prakash, Prabhjot Singh*, et al, 2021, J Clinical Urology, Published Online Jan 19^th

https://journals.sagepub.com/doi/pdf/10.1177/2051415820987663

With warm Regards,

Venu

Comments(1)

• 

  Dr. Roy Chally

  27 Jan 2021 02:53:58 PM

  24 nephrectomies for no functioning kidneys after 6 months of treatment for T B. 

  In 8 specimens live TB bacilli were grown and in 3 the bacilli belonged to the drug resistant group. The authors state that all nonfunctioning kidneys in TB should be removed as they could harbour active disease. 

         The fact that the kidneys had live tuberculous bacilli raises the question whether 6 months is treatment is adequate.

  I still believe in the 9month treatment protocol. There are many morphological reasons for the persistence of bacilli in the kidney. Usually they are inactive after treatment and nephrectomy is usually done, as this focus has the potential to  become active later in life. After completing the treatment, if the nonfunctional kidney is small and atrophic there is no absolute indication for nephrectomy. 

          The presence of resistant strain in 3 out of 24 specimens is unusual. Does this mean that the transformation to resistant strain happened with medication? This can happen if the treatment was interrupted. If the original infection was with resistant strain then we should have diagnosed this earlier, during follow up. These days should we do culture and sensitivity in all patients diagnosed to have GU.tuberculosis.I think that this is needed.,