This document discusses non-pulmonary tuberculosis, specifically renal (kidney) tuberculosis. It outlines the risk factors, most common sites of infection, pathogenesis, signs and symptoms of renal TB. It then describes the laboratory diagnosis including hematology, chemistry, histology, microbiology tests and results. A case study is presented and diagnosed as renal TB based on positive acid fast bacilli staining, PCR, culture and histology findings. Risks, treatments, and references are also summarized.

1. NON-PULMONARY
TUBERCULOSIS
KHAWULA
WONDERBOY
21527981

2. INTRODUCTION
Non-pulmonary tuberculosis and it’s risk
factors
Low socioeconomic status
Immunosuppresion
Contact with a person who has active
or latent TB
Immunodeficiency

3. MOST COMMON SITES FOR
NON-PULMONARY TB
Lymph nodes
Meninges
Spine
Bones
Kidney (Renal)

4. PATHOGENISIS
The inhalation and spreading of MTB to other body
organs and tissue
www.tbmanufasthtm.com

5. RENAL TUBERCULOSIS
Signs and Symptoms
Dysuria
Haematuria
Constitutional Symptoms
Kidney Failure
Back flank/Abdominal pain
www.renaltbhtml.com

6. DESCIPLINES
CHEMISTRY HAEMATOLOGY
MICROBIOLOGY(MAIN)
HISTOLOGY

7. CASE-STUDY
A 34-year old man sought medical attention due to a
6-months history of dysuria, macroscopic haematuria,
polyuria and supra-pubic pain associated with
sporadic vespertine fever, sometimes with chills. He
had also experienced weight loss, however he
attributed this to intentional dietary restriction as he
was obese.

8. LAB DIAGNOSIS
www.labdiagnosistml.com

9. HAEMATOLOGY
Specimen: Blood(EDTA-tube)
Tests: FBC
: ESR
www.eclinpath.com

10. CHEMISTRY
Specimen: Venous Blood
: Urine
www.alibaba.com

11. HISTOLOGY
Specimen: Kidney Biopsy
TheAnswerVet.com

12. HISTOLOGY
Haematoxylin and Eosin Stain Ziehl-Neelsen Stain
www.pathologyatlas.ro

13. MICROBIOLOGY
Specimen: Urine(EMU)
AFB smear
Mycobacterium Culture
Nucleic Acid Amplification
Drug Susceptibility Testing
Tuberculin Skin Testing
www.labroutine.com

14. MICROBIOLOGY
Day1
AFB SMEAR
1. Z-N Stain
•EMU specimen received.
•3 to 5 daily specimens.
•Concentrated by centrifugation.
•Smears prepared from sediment
•Z-N staining.
www.slidelab.com

15. MICROBIOLOGY
2. Aura-mine-O Dye(stain)
•Urine smears stained by aura-mine-O-dye
•Smears examined under Fluorescent
microscope.
www.tbauraminedye.com
250X---450X Magnification

16. CULTURE
CONVERTIONAL
 SOLID MEDIA
 Lowenstein-Jensen:
egg based.
 Middlebrooks 7H or
7H11: agar based
 LIQUID MEDIA
 Middlebrooks 7H12
AUTOMATED
 LIQUID MEDIA
 BACTEC 460 TB MGIT
 Drug susceptibility
testing
www.labroutine.com www.mtb.com

17. OTHER DIAGNOSTIC TESTS
Line Probe Essay(PCR)
 Rapid molecular technique.
 Detects M.tuberculosis DNA within 48hrs.
www.lineprobeessay.com

18. RESULTS
www.medscape/drugsusceptibilitytestingintb.com

19. MANTOUX TEST
 Known as Tuberculin skin test.
www.pinterest.com

20. DIFFERENTIAL DIAGNOSIS
1. Acute Cystitis.
2. Schistosomiasis Haematobium (endemic areas).

21. CT SCAN
Unenhanced scans show bilateral renal
calcification.
A. Dilated calices in the left mid-
kidney(arrowed).
B. Mixed-attenuation left lower pole mass
containing calcification.
A B
www.stoptb.org

22. FINAL DIAGNOSIS
Renal Tuberculosis present.
 Haematoxylin & Eosin: TB granuloma present.
 Ziehl-Neelsen stain: Acid Fast Bacilli(AFB)
present.
 Aura-mine O dye: AFB seen (yellow<black bg)
 Tuberculin Skin Test: Positive.
 Line Probe Essay(PCR): TUB band seen.
 CT scan: Renal Calcification seen.
 First line Drug: Sensitive.

23. RISKS AND COMPLICATIONS OF
RENAL TUBERCULOSIS
Hypertension
Hydronephrosis
End stage Renal Failure

24. PREVENTION AND TREAMENTS OF
NR-TB
• Vaccines: Bacillus calmette-Guerin(BCG)
• Drug treatment: Rifampicin and Isoniazid
6 months therapy
9-12 moths for meninges
• Corticosteroids may help in pericarditis and meningitis
• Surgery is required for the following
To drain empyema, renal abscess
To stop the further spread of Tuberculosis

25. REFERENCES
1. Eastwood JB, Roodhouse CM and Grange JM. 2001 Tuberculosis
and Kidney. J Am; 12:1307-1314.
2. Dasher E.F, Silva GB, Jackson EJ. Renal tuberculosis in the modern
era Am J Trop Med Hyg2013; 88: 54-64.
3. WHO.2010.Treatment of Tuberculosis guidelines. WHO; Geneva:
85. www.who.int/tb/en/ (23/09/2017).
4. www.who.int/tb/features_archive/lineprobeassay_rapidtb-test
(17/08/2017)
5. www.who.int/tb/areas-of-work/laboratory/policy-statements
(20/10/2017)
6. www.medindia.net/drugs/medicalcondition/tuberculosis.htm

26. AKNOWLEGDEMENT
Nonsikelelo Nxele (Intern)
Dr T.Reddy (Pathologist at IALH)
Prof. S Moodley
Mrs V Nundkissor
Mrs N Mbatha

27. YOU