TRUE NATURE OD RENAL TUBERCULOSIS

My investigations have evidenced that all that is currently considered to be renal tuberculosis is only “top of the iceberg”. Only small part of a widely distributed and highly important pathological substrate is recorded and understood. Without any dilemma I am sure that it is so insufficient and essentially wrong and absolutely opposite to all that what is considered to be renal tuberculosis by a doctrinal medical science. Renal tuberculosis is ERRONEOUSLY IDENTIFIED DISEASE.

TRUE NATURE OF THE RENAL TUBERCULOSIS is manifested in many ways and I will present conclusions based on my discoveries:

1. It is THE MOST FREQUENT RENAL DISEASE and one of the most frequent diseases in men, if not the most frequent one!

2. It is not post-primary but PRIMARY disease absolutely unrelated to the pulmonary tuberculosis.

3. It does not affect single kidney, but BOTH kidneys, however to different extent.

4. PRIMARY FOCI ARE SOURCES OF renal tuberculosis in the parenchyma of the upper poles.

5. ACTIVATION and reactivation of primary foci as well as development of the new TB foci STARTS AS EARLY AS IN THE FIRST YEAR OF LIFE and in different time intervals in may be present throughout the life.

6. Renal tuberculosis is exceptionally DYNAMIC PROCESS with diverse and tumultuous progressive and most frequently rapid regressive changes. Regressive changes are decelerated in presence of extreme impairment of the local and general immunity and onset of superinfections caused by unspecific microorganisms.

7. If considered throughout the life span, INCIDENCE OF the disease SIGNIFICANTLY EXCEEDS 50% OF POPULATION. Local indicators in the region where I live and work suggest that even in 80% of human population activation of primary TB focus takes place at least once in the lifetime. (This does not apply to primary TB foci in general, either inactive or activated at any point of time – they are present in 100% of population, as it has been already mentioned above!).

8. Renal tuberculosis is TRUE CAUSE OF renal calculosis, microlithiasis, ureteral stricture with consequential hydronephrosis, and chronic inflammatory changes in the genitourinary tract: pyelonephritis, cystitis, prostatitis, vesiculitis, epididymitis, and adnexitis...

9. Upon each activation of primary TB foci, which takes place in more than 50% of population, tuberculosis also AFFECTS to greater or lesser extent ADRENAL GLANDS. The whole gland is only exceptionally affected and only from one side (I have recorded only two cases on the total studied sample – in all other cases only partial lesions were present).

10. Except for extremely rare cases, the disease is OLIGOSYMPTOMATIC , usually characterized by the picture of mild urinary infections, disuric complaints, short-lasting painful episodes with microhematuria. Relapsing urinary complaints are rather characteristic finding, frequently occurring from early childhood (detailed description of the possible subjective complaints is presented in the book).

11. HEMATURIA (either macro or micro) is characteristic for renal tuberculosis and not piuria, as currently considered. Piuria is actually the consequence of unspecific superinfections developing either in the course of activation of tuberculous foci or later, after initiation of the regressive changes.

12. DIRECT ADVERSE EFFECTS ON THE KIDNEY AND ORGANISM IN GENERAL ARE NOT EXCESSIVE. Circumscriptive zones permeated with fibrous tissue remain in the parenchyma and they are recognizable on the ultrasound examination throughout the life. Occasionally, they contain calcifications or small cavernous spaces ultrasonographically recognized as cysts, while they actually represent healed TB foci. In 99,99% of cases the process is spontaneous since the kidney is capable, owing to excellent vascularization, to combat against tuberculosis with great success. In the remaining, scarce, cases the process takes place after anti-tuberculous therapy. ULTRASONOGRAPHIC PICTURE OD TB CHANGES IS ABSOLUTELY THE SAME IN PATIENTS WHO HAVE HAD ESTABLISHED RENAL TUBERCULOSIS AND UNDERWENT RELEVANT THERAPY AND IN ALL OTHER GENERALLY HEALTHY INDIVIDUALS WHICH is the fact of the utmost importance with decisive influence on resolution of the problem of renal tuberculosis. Nevertheless, these old TB foci represent locus minoris resistentiae, through which, unspecific microorganisms attack human kidneys upon each impairment of local or general immunity (this is why we are so frequently and persistently attacked by E.Coli, which is an intestinal saprophyte!).
    These unspecific superinfections give specific characteristics to clinical picture, laboratory and microbiological findings (urine culture) which makes difficult for the physician – therapist to suspect renal tuberculosis as an underlying cause.

13. INDIRECT ADVERSE EFFECTS OF RENAL TUBERCULOSIS ARE IMMEASURABLY MORE EXCESSIVE! These old tuberculous foci are responsible for such extensive and diverse pathology of the kidney and whole genitourinary system. It is absolutely sure that in absence of these lesions, such widely distributed in human population, kidney resistance would have been much better. Both kidney and whole genitourinary tract would have been spared from numerous pathological conditions, their consequences and complications. In practical medicine, urological and nephrological casuistic would have been drastically reduced, which also applies to other fields of medicine dealing with consequences of the above-mentioned conditions.
    On the individual level, the above is not such obvious. It is evidenced that vast majority have no urinary complaints or if present, they are only mild and manifested by short lasting episodes and thus they are disregarded. Certain percentage of population have relapsing urinary infections while others experience one or two painful episodes of the renal colic-type over the lifetime, explained as microlithiasis by their physicians. Calculosis is less frequently found. Relatively large number of people suffer from occasional disuric complains or dull pain in the lumbar region, under right of left costal arch. Even if they present to a physician, these complains usually remain diagnostically unresolved Reduced capacity of the urinary bladder is frequently evidenced. General health condition impairment, usually transitory, may be evidenced in some people, including: subfebrile body temperatures, fatigue, and malaise. Some of them also have more prominent complaints in presence of verified calculosis, chronic pyelonephritis with or without complications, chronic cystitis of different degrees occasionally even with fibrous induration of the organ walls, chronic prostatitis, epididymitis, adnexitis, etc.
    Once again, on the individual level, the above is not such obvious. All these conditions are substantiated by doctrinally established diagnostic and therapeutic solutions. All appears to be regulated with more or less success.
    However, ON GLOBAL LEVEL ALL APPEARS QUITE DIFFERENT!
    Let us count all the people who experience some of the above-mentioned from early childhood till end of their lives. (The list is less exhaustive in this text in comparison to the one presented in the book). Let us try to imagine how many people are treated using different antibiotics, uroseptics, spasmolytics, sedatives, etc., and to how many examinations they are subjected to, what kind of equipment is needed for that as well as highly specialized professionals and other experts is engaged in their diagnosis and treatment, to what extent is reduced their working ability, psychic health disturbed as well as social adaptability and family relations!? Finally, LET US TRY TO ASSESS THE COSTS OF ALL THE ABOVE-LISTED! The least expensive is anti-tuberculous treatment of these patients, however, such treatment is still not free of charge.
    I have EQUALLY detected these tuberculosis-induced changes in apparently healthy individuals FROM THIS REGION AND ALL OTHER PARTS OF THE WORLD, e.g. Western Europe, USA, Canada. I am stressing this in the light of fact that pulmonary tuberculosis is almost eradicated in these countries. However, THIS IS THE CASE OD RENAL TB THAT MAY AFFECT ANYONE FOR THE TIME BEING!
    There are about 6.5 billion people on the planet Earth. Let us try to imagine the total damage – health-related, social and economical that may result from this ESSENTIALLY UNKNOWN DISEASE! What would be the results of an effective preventive protection aimed at prevention of development of primary TB foci in the kidneys, or at least at prevention of their activation?

14. Each activation or reactivation of a tuberculous focus in the kidney, either primary or newly developed, is accompanied by certain processes – first exudation and infiltration, followed by necrosis and caseification with mandatory discharge and escape of the necrotic detritus into the collecting system of the kidney. Naturally, detritus contains Mycobacterium tuberculosis. Upon urination, it is evacuated from the organism and comes into the contact with natural environment. Most of the detritus is discharged during the initial two days, while lesser quantities are discharged for 5 –6 days, only infrequently longer (in case of superinfections). Significantly more than 50% of human population has one or more activations over the lifetime. Let us see it from the global point of view!
    Undoubtedly, epidemiological significance of the renal tuberculosis is considerable, immeasurably greater than the significance of pulmonary tuberculosis. The kidney is crucial link in survival of Mycobacterium tuberculosis in nature, i.e., key to complete eradication of tuberculosis as human disease.