Significance of Nephrectomy in Renal Tuberculosis Patients with Negative Urine (AFB) Culture and Asymptomatic Nonfunctioning Kidney

Kim, Do Ri; Choi, Ho Cheol; Choi, Sung Hyup

Abstract

PURPOSE: The aim of this study was to evaluate the surgical treatment of incidentally detected, asymptomatic, unilateral nonfunctioning tuberculous kidney.
MATERIALS AND METHODS
Thirty-three patients with incidentally detected, asymptomatic, unilateral nonfunctioning kidney, negative urine AFB culture and radiologic diagnosis of renal tuberculosis were reviewed. They were divided into three groups: surgical, medical, and observation groups. Twelve patients in the surgical group were nephrectomized at initial diagnosis. Eleven patients in the medical group received anti-tuberculous medication with isoniazid, rifampin, and pyrazinamide for 4 months. Ten patients in the observation group remained under observation.
RESULTS
There was no evidence of decreased renal function or recurrence of renal tuberculosis in the surgical and medical groups. Pathologic confirmation of renal tuberculosis was obtained in all nephrectomy patients. The follow-up loss rate of the surgical group (7.7%) was lower than that of the other groups (p<0.05).
CONCLUSIONS
Nephrectomy is more acceptable than either medicine or observation. (1) Because preoperative chemotherapy was not justified in the case of negative urine AFB culture, pathologic confirmation was necessary. (2) Nephrectomy associated morbidity was quite low. (3) The follow-up loss rate of the surgical group was lower than that of the other groups. Short course anti-tuberculous medication should be administered after nephrectomy.