STUDY ON CHEMOTHERAPY FOR RENAL TUBERCULOSIS

REPORT 3. PARTIAL NEPHRECTOMY

Abstract

Partial nephrectomy is performed as one of the treatments to conserve the kidney after the sites are removed, and has been prevailed for treatment for renal tuberculosis, since the appearance of effective chemotherapeutic agents as well as an increase in reliability of radiographic examinations.
Incidence to perform partial nephrectomy has been gradually decreasing for the recent improvement in chemotherapeutic agents (antibiotics) and other reasons.
In 18 tuberculous kidneys of 18 cases which were performed partial nephrectomy pathohistological examination was made.
The result is as follows:
As the result of examining the tissues of the specimens, the cases were divided into the following 4 groups; 1) 3 cases in which a active tuberculosis was noted, 2) 4 cases in which a tuberculous proliferation was noted, 3) 6 cases in which a tuberculosis was noted to be healed up, 4) 5 cases in which no tuberculous condition was not found other than pyelonephritis.
As to the application of chemotherapy before partial nephrectomy, chemotherapy was not applied to all the 3 cases of group 1, and to 1 of the 6 cases of group 3.
Two of the 5 cases with pyelonephritis were not diagnosed either on tissue examinations or on clinical symptoms, but in 1 case, tuberculous bacilli were discovered in urine, and in 2 cases complicated with urogenital tuberculosis of other organs.
As to 7 of the 13 cases with renal tuberculosis which was distinctly confirmed; 2 cases of group 2 and 5 cases of group 3 chemotherapy was proved to be effective, as compared with 6 cases without chemotherapy which consisted of 1 cases belonging to group 4, 2 cases belonging to group 3 and 3 cases belonging to group 1.
As to the relation between pathohistological findings and the result of urine examinations, sediments and protein were positive in all cases of group 1 and also tuberculous bacilli were positive in 2 of the 3 cases of group 1. But sediments were positive in 1 of the 6 cases belonging to group 4, protein was positive in 2 of the 6 cases, and tuberculous bacilli were negative in all the 6 cases. That is, there is a close relation between pathohistological figures and the result of urine examinations.
As to pathohistological findings and pyelograms, all the 6 cases belonging to group 4 showed the stricture at the neck of the renal calyx.
I came to the following conclusion:
For the cases with chemotherapy of 6 months duration in which pyelogram show the stricture of the neck of calyx with markedly improved urinary findings partial nephrectomy is the therapy of choice.