THE WAY IN WHICH THE INVESTIGATIONS WERE PERFORMED

I have applied, for diagnosis of renal tuberculosis my own technique of ultrasonographic examination. Verification of my findings was performed by therapists from different health institutions and it was based on Löwenstein microbiological test, PCR or both. They were responsible for prescription of therapy in according to the existing doctrinal views.
The investigations were neither team-based nor coordinated but absolutely individual, performed within my routine work in my private office for ultrasound diagnostics.

The following three basic factors enabled me to perform the investigations:

• My own, new technique of ultrasound examination of the kidneys. Standard examination would not be capable to enable that.

• Patients’ confidence build after almost 40 years of work in the same region. Without such confidence it would not have been possible to have the opportunity to examine the same patients repeatedly – since they always used to come back to me for scheduled follow-up examinations in case of deterioration of their condition or development of new complaints and comply with my instructions, regardless of where they went in the meantime.

• Maximum utilization of clinical approach with due attention paid to each problem: careful and detailed history, clinical picture (years-long experience has helped me to observe some important details on the first glance), all the collected hematological, biochemical, microbiological, radiological and other findings. I have compares all of them with ultrasonographic findings using different based on my opinion, relevant criteria.

Without unnecessary details, I will list only terms and categories that I had addressed:

• Patients undergoing therapy for renal TB - all adults,

• Patients with different urinary complaints treated for unspecific urinary infections, based on findings of urine culture or empirically – all age groups, including children.

• Patients with minimum urinary complaints without therapy - all age groups.

• Patients free of any urinary complaints but with pathological urine findings - all age groups.

• Patients with unidentified and undiagnosed abdominal complaints, sometimes even after repeated examinations performed for years - all age groups,

• Patients with all kinds of abdominal complaints out of the urinary tract –all age groups,

• Patients free of any complaints presenting for regular check-up – all age groups,

• Patients presenting for any kind of extraabdominal complaints (I have subjected them to kidney examinations, as well) – all age groups,

• Patients who had suffered (some of them since early childhood) and were treated for inflammatory and other diseases of the genitourinary tract, currently with certain complaints or free of any complaints.

• Patients ho have been treated at any point of time from pulmonary tuberculosis, regardless of the reason of their presenting for examination - adults.

All the observed changes were analyzed including the parameters related to sex, age, social status, and geographical origin, national and racial category.

PARTICULAR ATTENTION WAS FOCUSED ON CORRELATION OF ULTRASONOGRAPHIC FINDINGS OF TB FOCUS IN DIFFERENT PHASES OF TB PROCESS AND MICROBIOLOGICAL TEST (LÖWENSTEIN) AND PCR.
I HAVE CONSIDERED AND ANALYZED WITH PARTICULAR ATTENTION THOSE KIDNEY CHANGES AND CHANGES IN OTHER PARTS OF THE GENITOURINARY TRACT AND ADRENAL GLANDS WHICH GRADUALLY BECAME UNDERSTANDABLE FOR ME TO BE FINALLY INTERPRETED FROM THE ASPECT OF THEIR TUBERCULOUOS ETIOLOGY.

I have assessed:

• Efficacy of Löwenstein microbiological test and PCR as well as their suitability for true nature of renal tuberculosis,

• Value of the existing criteria for introduction of antituberculous therapy and length of its duration,

• Real effects of the existing anti-tuberculous therapy, having in mind frequent development of new TB foci in the kidney even several months after its introduction, in some cases as late as after 9 or 12 months!

• Real need for treatment of the renal TB, having in mind spontaneous regression and healing of TB foci in most of the population without any significance whether the results of the microbiological test were positive or not, or whether is was performed at all.