Role of Nephrectomy in the Treatment of Non-Functioning or Very Poorly Functioning Unilateral Tuberculous Kidney

Abstract

Consecutive cases (300) of genitourinary tuberculosis at Wrightington Hospital from 1961-1978 were reviewed. There were 73 patients with nonfunctioning or poorly functioning kidneys who underwent nephrectomy after at least 6 wk of intensive chemotherapy with 3 antituberculous drugs. Of 4 patients with unilateral nonfunctioning kidneys who did not have a primary nephrectomy 3 had delayed complications. Late complications of in situ nonfunctioning tuberculous kidneys included draining flank sinuses, abscesses and hypertension. These complications can occur years after completion of chemotherapy, even in sterile organs. The incidence of hypertension in this series was 11.3%. The incidence of hypertension in patients with unilateral nonfunctioning or poorly functioning tuberculous kidneys was 23.2% (P < 0.005). Of the hypertensive patients with severe unilateral tuberculous nephropathy 2/3 benefited by a decrease in blood pressure after nephrectomy. Removal of these kidneys does not cause a significant loss of renal function. The perioperative morbidity and mortality of the procedure should be minimal in a generally younger population. Primary nephrectomy is an important adjunct in the comprehensive management of the unilateral nonfunctioning kidney.