X-Ray KUB: Putty Kidney

1. Image of the week Jagdish K Dr.Prof.A.Gowrishankar’s unit

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. EXAMINATION well oriented, conscious , afebrile . General examination was unremarkable Pulse : 80/min BP : 160/90 mm of hg Systems : normal

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. Close up view of X-ray KUB

6. IVU

7. PUTTY KIDNEY What is “putty” ? What does putty kidney mean? How to diagnose it radiographically ? What is autonephrectomy ?

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. RENAL CALCIFICATIONS Dystrophic calcification due to localised disease: Usually one kidney or part of one kidney. Infections : Tuberculosis Hydatid disease Xanthogranulomatous pyelonephritis Abscess Carcinoma Aneurysm of renal artery

10. Contd . . . Nephrocalcinosis Medullary : Hyperparathyroidism RTA Medullary Sponge Kidney Renal papillary necrosis Causes of hypercalcemia or hypercalciuria Preterm infants Primary hyperoxaluria Cortical : Acute cortical necrosis Chronic glomerulonephritis Chronic transplant rejection

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. Symptoms of GUTB Increased frequency of urination Dysuria Flank pain Hematuria Unexplained infertility ASYMPTOMATIC presentation is not uncommon

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. CONTD… Radiography IVU

15. Management ATT Nephrectomy ?

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