X-Ray KUB: Putty Kidney

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X-Ray KUB: Putty Kidney

  1. 1. Image of the week Jagdish K Dr.Prof.A.Gowrishankar’s unit
  2. 2. HISTORY • 55yr old male presented to the OPD for getting drugs for hypertension & routine follow up. • Not a known DM. • Known HT for 1yr on irregular treatment • H/O TB when he was 35yrs old & completed ATT course. • No other significant history.
  3. 3. EXAMINATION • well oriented, conscious , afebrile. • General examination was unremarkable • Pulse : 80/min • BP : 160/90 mm of hg • Systems : normal
  4. 4. Contd… • Patient had been worked up in a private hospital in Bangalore & few investigations were available with him. • He presented to that hospital with abdominal pain 3 years back. • KUB was ordered as he was provisionally diagnosed to have renal calculus
  5. 5. Close up view of X-ray KUB
  6. 6. IVU
  7. 7. PUTTY KIDNEY • What is “putty” ? • What does putty kidney mean? • How to diagnose it radiographically? • What is autonephrectomy?
  8. 8. Other radiological features of renal TB • moth-eaten appearance • phantom calix • hiked-up or purse-string appearance • sawtooth appearance • pipestem ureter • beaded or corkscrew ureter • thimble bladder
  9. 9. RENAL CALCIFICATIONS A. Dystrophic calcification due to localised disease: Usually one kidney or part of one kidney.  Infections : 1. Tuberculosis 2. Hydatid disease 3. Xanthogranulomatous pyelonephritis 4. Abscess  Carcinoma  Aneurysm of renal artery
  10. 10. Contd . . . B. Nephrocalcinosis C. Medullary : 1. Hyperparathyroidism 2. RTA 3. Medullary Sponge Kidney 4. Renal papillary necrosis 5. Causes of hypercalcemia or hypercalciuria 6. Preterm infants 7. Primary hyperoxaluria D. Cortical : 1. Acute cortical necrosis 2. Chronic glomerulonephritis 3. Chronic transplant rejection
  11. 11. GUTB • Clinical symptoms develop 10 to 15 years after primary infection. • Only about a quarter of the patient with genito urinary involvement have known history TB • About half of these patients have a normal chest radiography findings
  12. 12. Symptoms of GUTB • Increased frequency of urination • Dysuria • Flank pain • Hematuria • Unexplained infertility • ASYMPTOMATIC presentation is not uncommon
  13. 13. INVESTIGATIONS • Tuberculin skin test • CBC, ESR, CRP • Serial early morning urine collection for AFB smear (atleast 3) • Serial culture LJ media • BACTEC 460 radiometric assay • PCR
  14. 14. CONTD… • Radiography • IVU
  15. 15. Management • ATT • Nephrectomy?
  16. 16. THANK YOU

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