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

Abstract

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.

Conclusion

A rare presentation in Tuberculous pyonephrosis that presents as an asymptomatic polycystic kidney is possible.