Publications

The urinary tract is a common site of tuberculosis, which causes significant morbidity in the form of chronic renal disease. T uberculosis is not only common in developing countries but with the spurt in the number of immune-suppressed patients and the increasing incidence of drug -resistant strains, an increase in the number of patients suffering from genitourinary tuberculosis is expected even in developed countries. Genitourinary tuberculosis occurs owing to haematogenous dissemination of tubercular bacilli. Urinary tract tuberculosis can result in complications such as ureteric stricture, chronic pyelonephritis and papillary necrosis, resulting in compromised renal function. This renal compromise makes it prudent to avoid contrast- enhanced studies if other alternatives are available. There is a dearth of-cases of papillary necrosis reported on static MR urogram. The authors report a case of tuberculosis complicated by papillary necrosis on both CT urogram and static MR urogram.

Background

Urogenital tuberculosis is the most common cause of extrapulmonary tuberculosis, affecting about 27% of patients suffering from it.1 Tuberculosis is not only common in developing countries; but with the spurt in the number of immune-suppressed patients and the increasing incidence of drug-resistant strains, an increase in the number of patients suffering from genitourinary tuberculosis is expected even in developed countries.1 Genitourinary tuberculosis occurs owing to haematogenous dissemination of tubercular bacilli.1,2 Discussed below is a patient from a low socioeconomic background who presented for evaluation of flank pain and weight loss. It is important to suspect and diagnose tuberculosis on imaging to direct the clinician to perform appropriate investigations such as culture for Mycobacteria. Appropriate treatment is necessary to prevent complications such as ureteric strictures, putty kidney, thimble bladder and tubercular renal abscesses.

Many patients with renal tuberculosis have compromised renal function. This makes it prudent to avoid the use of contrast in such patients. This case report aims to show that static MR urogram can be used to make the diagnosis of renal tuberculosis without the risks of contrast or radiation dose administration. This case report describes the findings of renal tuberculosis with papillary necrosis on static MR urogram.