Patient: Description of the condition (onset time, main symptoms, hospital visited, etc.): In May 2010, he was admitted to the hospital for Chinese and Western medical examination: severe hydronephrosis of the left kidney, thickening of the cystic wall around the entrance of the left ureteral bladder, considering inflammatory lesions causing stenosis of the left ureteral orifice; large bilateral seminal vesicle glands, and left renal puncture fistula, intraoperative drainage of yellowish turbid pus, pus examination suggested Mycobacterium tuberculosis On 06-21, he was sent to the operating room and underwent transurethral left ureteroscopy under lumbar anesthesia, during which he was found to have left ureteral stricture and was discharged with an F5 double “J” tube. The liver function test is normal, but the urine test is always negative for leukocytes, urine protein, urine occult blood, red blood cells, and white blood cells between 1+ and 3+.
Li Chao, Transplantation Center, 309th PLA Hospital: If the diagnosis of renal tuberculosis is made, your current treatment may have some problems; I don’t know if you have renal cortex invasion by renal tuberculosis, left kidney puncture that your fistula opening has healed ah.
Patient: Hello, what is the problem with the treatment? The left kidney puncture that your fistula has not completely healed, about five months; now the situation is that the urine test is always abnormal, some worry
Li Chao, transplantation center of the 309th PLA hospital: renal tuberculosis is contraindicated puncture, because the sinus tract is difficult to heal; with or without abdominal CT film, you need to understand whether the left kidney cortex has been damaged by tuberculosis, in order to decide the next treatment; currently the most afraid of your right kidney again infected with renal tuberculosis.
Patient: Hello, I didn’t know it was renal tuberculosis at that time, but I had a CT scan to find out that the left kidney had heavy fluid, and then when I did a puncture to drain the fluid, it was pus-like material, and then the test said it was Mycobacterium tuberculosis; how do I check if the right kidney is infected? How do I need to check to know if the left kidney cortex has been damaged by tuberculosis? My attending hospital, basically asked him nothing to say, several months of urine tests are abnormal, asked several times but did not say a reason, so I can only let the Internet to seek employment, trouble ah!
PLA 309th Hospital Transplant Center Li Chao: can enhance CT examination to understand, this infection is very troublesome ah, sinus tract healing is difficult, continuous anti-tuberculosis treatment is very necessary.
Patient: Sinus tract healing is difficult! Is it difficult to heal the sinus tract because of the influence of Mycobacterium tuberculosis? At that time, the tube was inserted for a month because there was a lot of pus, so it took a month to be removed. Should I use CT to check it? Thank you very much!
Li Chao, transplant center of the 309th PLA hospital: Yes, mycobacterium tuberculosis affects the healing of the incision; so you have to take tuberculosis medication regularly, otherwise the sinus tract may come back again; CT examination is mainly to understand the destruction of the kidney cortex and whether there is still fluid.
Patient: Yes, thank you! I am taking TB medication every day, it won’t affect my right kidney, right? I’ll go to Wuhan in a few days to have a checkup, what other tests do you think I need?
Li Chao, Transplantation Center, 309th PLA Hospital: The most fearful thing is the infection of the right kidney, we need to know the infection of the left kidney, so the kidney enhancement CT is very important.
Patient: Hello doctor, I have some pus in my wound for the past two days, and when I went to the hospital today to clean the wound, I found out that the previous one was false and sinus tracts were formed inside, and I am in a very depressed mood! The attending hospital told me to be hospitalized immediately for examination. Do you think I need to cut out the bad kidney to be better in this case? What else do I need to be examined by the doctor tomorrow? I don’t know what I need to know. Thank you!
Li Chao, transplant center of the 309th PLA hospital: Maybe you should consider resection, because hydronephrosis caused by kidney tuberculosis is already an indication for resection. It may be good to know the function of bilateral kidneys and do multi-parametric renal chart, the doctor will definitely tell you more about it.
Patients: I am Zhongshan Hospital in Guangdong, my primary care hospital has not encountered my disease, so often ask what can not say; five months out of the hospital only every time to check the urine test, but also do not want me to check the situation of the kidney; feel that the doctor can not cure me ah! Just now a relative who is a doctor strongly suggested that I should be transferred to Guangzhou Provincial Hospital! If the attending doctor is not willing to let me transfer, how do I proceed? Can they be held responsible? I can’t use the patient as a test case! Thank you!
Li Chao, transplant center of the 309th PLA hospital: If a patient requests to be transferred to another hospital, the doctor has no right to stop it! It is recommended to transfer to a general hospital with a tuberculosis institute, see more, and handle it smoothly.
Patient: My family means that they want to keep this kidney, even if only 5% of the function can be used;; but will this affect the other parts?
Patient: If I go to Guangzhou to find a hospital, what type of hospital should I look for?
Patient: Kidney 3+ liver function 8 items Urea nitrogen 4.19 1.79-7.14 Creatinine 98 40-120 Carbon dioxide 28 22-31 This is what I have to check every month, all are normal, do you see if you still need to check those to determine the condition of the kidney?
Li Chao, transplant center of the 309th PLA hospital: you must stay, you must not hesitate to stay. It is recommended to be psychologically prepared for the removal of the other kidney, but if the other kidney is well protected, it is enough to last you a lifetime. It is recommended that multi-parametric renal chart to understand the glomerular filtration rate of bilateral kidneys to assess how the function of the right kidney? If it is good, it is recommended to remove the left kidney and consider stopping it after a year to a year and a half of regular long-term TB medication.
Patient: I went for imaging this morning and found that the tube fell out of my body, resulting in fluid in my left kidney again, no wonder the puncture did not heal! The attending doctor told me to have surgery next Monday and put it back on! I didn’t ask what to do afterwards! I don’t think all patients with kidney TB will be removed, right? If you want to cut the kidney, how far do you think you have to go before you will cut it?
Li Chao, transplant center of the 309th PLA hospital: I don’t know the destruction of your kidney cortex, if possible you send me the abdominal CT enhancement, I will help you to see. If the kidney tuberculosis has developed to hydronephrosis, it means that the kidney tuberculosis has invaded the ureter, and there is a serious ureteral blockage leading to the possibility of kidney self-excision. In this case, nephrectomy is generally considered, otherwise your subsequent treatment is very tricky and difficult to get a fundamental solution. To put it bluntly, the hospital you visited may have misunderstood the treatment of renal tuberculosis, and it is recommended to consult a higher level hospital.
Patient: I was going to take a CT today, but my family thinks it’s useless to do so now that the tube has fallen out, so I might as well wait for the tube to be inserted and let the accumulated water see if it can come down, then take a CT and go to Guangzhou for consultation on whether to cut the kidney in the current situation. When the puncture was done, it came out as pus, not water, so it should be the most serious kind! Now I only have the 3D CT from May, but only the film, no picture version, how can I upload it?
The transplant center of the 309th hospital of the PLA, Li Chao: We suggest you to follow your local hospital’s treatment. No need to intubate, go directly to the urology department of the hospital with the Institute of Tuberculosis in Guangzhou
Patient: I asked my doctor for a CD-ROM of the May CT today, and I’ll send it to you tonight! A hospital with a tuberculosis research institute! How should I look at this? I looked up on the Internet, Guangdong People’s Hospital and the First Hospital of Sun Yat-sen University seem to be more famous!
Li Chao, transplantation center of the 309th hospital of the PLA: I have to travel in these two days, so don’t be in a hurry if the reply is slow because then there is authority on the treatment of kidney tuberculosis. Okay, you send it to see.
Patient: Wait a minute, I have to go home around 11pm to send it! I’m planning to go to Guangzhou on Monday for a consultation, I’m so desperate! You just said you were looking for a hospital with a tuberculosis research institute, but I can’t find any information about it on baidu. I only know that Guangdong People’s Hospital and the First Hospital of Sun Yat-sen University These two are very famous!
Patient: Hello, I had a left nephrectomy on the 11th of this month and was discharged from the hospital today, but in the past few days, I’ve been experiencing abdominal surge and farting every day, and I have stools every second day, but they’re very dry, and they’ve been like this since I took tuberculosis medicine.
Li Chao, transplant center of the 309th PLA hospital: finally removed, removal is probably the right choice. Other symptoms will get better slowly
Patient: That’s the only way! My father said that the left kidney was full of pus! It’s been half a month now, but my stomach is still bloated, and I suspect I have intestinal adhesions! I’m not sure if there’s a good treatment. I’ve been to the gastroenterology department at the hospital, but I was only prescribed some digestive medicine, and after two or three days, the symptoms didn’t decrease much.
The PLA 309th Hospital Transplant Center Li Chao: I do not know how you operate, the principle should not enter the abdominal cavity, gastrointestinal complications rarely ah!
Patient: You see what is the problem with my symptoms? Do I need to see a doctor again?
PLA 309th Hospital Transplant Center Li Chao: Adjust the diet and improve the gastrointestinal tract! It will be fine!
Patient: Hello, Dr. Li! It’s been three months since I was discharged from the hospital, and yesterday I went to the hospital to check the status of Mycobacterium tuberculosis, and the quantitative report of nucleic acid, Mycobacterium tuberculosis <50 copies, and all urine tests are normal; the doctor said it's fine. Is this test report normal?
Li Chao, transplant center of the 309th PLA hospital: you have to take a year to a year and a half level after nephrectomy even if the result is ideal, be careful to review!
Patient: Do you mean you have to take medicine for a year to 1.5 years? Do you see my review, is it normal?
Li Chao, Transplantation Center, 309th PLA Hospital: It is very difficult to detect Mycobacterium tuberculosis in the retest, so continue to take oral anti-tuberculosis drugs!
Patient: Hello, you said it is difficult to detect this retest, so how can you determine whether the bacillus is good in the future? Also: Can I take a hot spring in this case?
Li Chao, transplant center of the 309th PLA hospital: You can take hot springs, and I’ll tell you to review those items after a year to a year and a half of taking them.
Patient: Hello doctor, I’ve attached two pictures, please take a look! The physical examination report was done at the end of June, and the urine test report was rechecked today, in which the urine occult blood (BLD) in both reports is weakly positive, and the uric acid UA is always high! Usually, I have no urge to urinate, and my scrotum is getting bigger and sagging. I used to remember that it would contract after taking a shower, but basically it hasn’t contracted since the surgery, and now it doesn’t contract at all, and I feel like I have no control over it. Thank you!
PLA 309th Hospital Transplant Center Li Chao: The test results are okay, usually drink more water uric acid is too high and diet related, are you currently also taking anti-tuberculosis drugs, Biazinamide has a great impact on uric acid.
Patient: Hello doctor, I stopped taking the medication in October and had a urine test and quantitative nucleic acid test, should I have other more detailed tests? If it is good for now, can I have children and how long can I stop taking the medication? Thank you.
Li Chao, Transplant Center, 309th PLA Hospital: After nephrectomy, it is recommended to take anti-tuberculosis drugs for a year to a year and a half, I don’t know if you have reached the course, but I suggest to review it after six months.
Patient: My primary care doctor and other doctors in the department told me to stop taking the medication, saying that I had taken it for six months before surgery and I had taken it for almost 10 months after surgery! What are the specific items to be checked in the review, and do I need to check the right kidney?
Patient: Do I need to pay some attention to food and exercise? Thank you!
The transplant center of the 309th PLA hospital Li Chao: need to check is: urine to find antacid bacilli, at least three times in a row above the blood sedimentation nodal test PPD test conditions can be PCR analysis review ultrasound or CT to understand the situation of the right kidney and bladder blood sampling to understand the liver and kidney function urinary routine diet to reduce pickled products, barbecue, preservatives containing fast food and other categories do not eat, as far as possible fresh and highly nutritious food to improve Immunity exercise to their own not tired mainly
Patient: Yes, thank you very much!