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Current attitude toward diagnostics of the renal tuberculosis is based
on poor understanding of its true nature. Renal tuberculosis is rather
dynamic process with rapid progressive-regressive changes. Verification of findings (or
suspected cases!) with microbiological tests (Löwenstein) and PCR, is
justifiable but only if not performed BLINDLY! I would like to stress
that the focus is ultrasonographically visible as well as its
ACTIVATION – WHICH IS THE MOMENT WHEN THE SAMPLES ARE TO BE OBTAINED TO
BE EXAMINED! When the regressive changes are initiated Mycobacterium
tuberculosis cannot be found in urine!
The extent to which the existing methods are static and inadequate for
true nature of the disease is illustrated by the Löwenstein test
results which are to be waited for 60 days! I have followed-up
ultrasonographically the patients who received positive results of the
test after 60 days of waiting. The focus that was active 60 days ago
and from which Mycobacterium tuberculosis was excreted into urine, was
most frequently completely healed by that time. Adhering to the
doctrinal attitude, the therapist introduces anti-tuberculous therapy –
6 months. Useless and noxious!
Or, other extreme scenario! After 60 days of waiting the patient
receives negative results of the Löwenstein test (negative due to
erroneous timing of sampling). Attending physician fails to administer
the therapy in spite of the fact that the patient feels bad, but
requests repeated testing which is consistent with the prevailing
doctrine! However, my examination of the same patient, results in
identification of not only one but 5-6 new foci! The first focus is in
the phase of advanced regression, even healed, while others are in
different phases of regression with one of them being extremely “dark”,
hypoechogenic and obviously fresh.
The therapy is not applied. The situation is not that bad in absence of
superinfection. However, the parenchyma affected with this kind of
lesions is susceptible to superinfections which will become later in
life major problem of patients, with possible development of
pyelonephritis and many other pathological conditions. In some
patients, Löwenstein test findings were negative 2-3 times, due to
already explained reasons. Therefore, neither physician nor patients
are willing to perform additional repetitions – and the situation
remains unchanged.
The possibilities are numerous, however one BASIC CONCLUSION MAY BE
DRAWN – ULTRASONOGRAPHY (USING NEW TECHNIQUE) IS THE ONLY DIAGNOSTIC
METHOD CAPABLE TO FOLLOW-UP RENAL TUBERCULOSIS.
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