Tuberculosis of Kidneys and Genital Glands

The tuberculosis of kidneys, testicles or ovaries (genital glands) is always secondary to primary lesion in the lungs, lymph glands or bones. The tuberculosis of kidneys may occur in early adult life. In the beginning it is commonly confined to one kidney but can spread to second kidney if chemotherapy is delayed. If the disease is not detected and treated well in time, it may spread to urinary bladder. In addition to low grade fever in the evening, feeling of general weakness and loss of appetite, it has three additional symptoms: increased frequency of urination, painless hematuria or passage of red blood cells or blood in the urine and a feeling of dull pain in the lower back or region of loin. The 'tubercular toxemia' is there. The treatment with anti-tubercular drugs is must to avoid surgical nephrectomy.

The tuberculosis of testicles or ovaries (genital glands) is also a serious manifestation of pulmonary tuberculosis. Initially there is swelling of one testicle in the male patient which can be easily felt. Later on it may transform into 'cold abscess' and a sinus is produced. Such patients show highly reactive 'tuberculin test'. The diagnosis is not difficult in a case of 'tuberculosis of ovary'. The swelling of the ovary can be palpated by experienced gynaecologist or can be detected by abdominal ultrasonography. The diagnosis can be confirmed easily by 'fine needle aspiration cytology' (FNAC). The signs and symptoms of 'tubercular toxemia' are there as stated in the case of tuberculosis of kidneys. The treatment with anti-tubercular drugs is must to avoid surgical removal of testicle or ovary.

The treatment begins with active anti-tubercular therapy by the use of at least three drugs and a longer course of treatment may be required in these cases. Surgical treatment will be required if the medical treatment alone is not capable of controlling the disease. If the disease is unilateral in one kidney or one testicle and there is no arrest of the disease with medical treatment, these organs would have to be removed surgically with informed consent of the patient.

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Dialysis Technology: Application of dialysis in acute renal failure !

Our kidneys are destined to perform excretory as well as regulatory function to maintain a state of homoeostasis in our body. Acute renal failure (ARF) is a syndrome defined as sudden or rapid loss of renal function (kidney function) leading to accumulation of urea and creatinine (nitrogenous waste compounds). If hyperbolic relationship between plasma creatinine or urea and glomerular filtration rate (GFR) is observed after investigations, the diagnosis is established as ARF. The early clinical signs of ARF/uremia are anorexia, nausea, vomiting, and sometimes pericarditis also. The ARF is an implication of loss of more than 50% of renal function. Dialysis should be instituted whenever early signs of uremia (elevated levels of urea in the blood) are present. Cases of metabolic acidosis as well as electrolyte and fluid imbalance also need dialysis for the reversal of hemodyanmics to normal.

Dialysis is a procedure for artificially purifying the blood of a patient through meticulous surgical intervention and electromechanical equipment. No specific elevated value of plasma creatinine or urea could be regarded as critical. The fluid intake and nutritional requirements are taken into consideration for deciding the timing and mode of dialysis. Cases of ARF should be put on dialysis without much delay for the successful recovery of their renal function. However, cases of chronic renal failure (CRF) may be kept in waiting. The dialysis procedure is of two types: i)  Hemodialysis (where patient's blood is passed through artificial kidney in conjunction with dialysis solution) and ii)  Peritoneal dialysis (where dialysis fluid is passed through the abdominal peritoneal cavity of the patient). The technique of dialysis was established long back in USA by Dr. Alan P Kendal, who also patented a 'suitcase kidney' in 1978.

Conventional hemodialysis remains the preferred and the best mode of dialysis. The hemodialysis is ideal for non-hypotensive and hemodynamically stable patients. Peritoneal dialysis is probably less effective in patients with hypercatabolic disorder and/or with undiagnosed abdominal disease. Peritoneal dialysis should be avoided in patients with recent abdominal surgery. The surgical intervention for hemodialysis can be in the following ways: i)  Continuous arteriovenous hemofiltration (CAVH), ii)  Continuous arteriovenous hemofiltration with/without concomitant dialysis (CAVHD), iii)  Continuous veno-venous filtration (CVVHD). These hemodialysis techniques are simpler, safe and very effective. The biochemical recovery is monitored during the dialysis for needful correction of fluid and electrolytes. After successive dialysis sessions the patient would return to normal health.