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腎結石으로 診斷된 腎臟結石 4例

Undifferentiated Renal Tuberculosis Under the Mask of Renal Calculus

중앙의학 1963년 5권 2호 p.109 ~ 114
林秀吉, 金麗性,
소속 상세정보
林秀吉 (  ) - 가톨릭大學 醫學部 泌尿器科學敎室
金麗性 (  ) - 가톨릭大學 醫學部 大學院生

Abstract


The diagnosis of renal tuberculosis should be based upon radiographical evidence and animal inoculation, together with clinical history.
However, when function of the kidney is lost on excretory urograms or formal function studies, and cystoscopy is not remarkable, the diagnosis becomes a problem. If there is a radiopaque shadow which seems to be renal calculus on the nonfunctioning kidney area, renal stone may more easily be considered as a possible diagnosis rather than the renal tuberculosis.
Dr. Ackerman (1953) also stated previously that the coincidence of renal calculous disease in the tuberculous kidney.
Now we have learned that antituberculous chemotherapy accelerates the fibrotic,, changes in the tuberculous lesion and bring about the stricture on ureter or ureteropelvic junction.
Since antibiotics for tuberculosis has been developed, possible supervening occurrence of renal stone over renal tuberculosis has beeii occasionally the subject of discussion.
This paper reports on 4 cases that has renal calculus with underlying tuberculous kidney which had been diagnosed to be cases of renal stone preoperatively during the past one year at this hospital.
Case. Ⅰ
Well rounded radiopaque density appeared in the upper portion of the left kidney, and on retrograde pyelograms appeared to lie free in a calyx.. By surgical exposure, the kidney cortex revealed tuberculous nodule and therefore nephrectomy to be performed. In this the surgical specimen revealed both renal stone and renal tuberculosis.
Case. Ⅱ
Round mottled radiopaque shadow was seen on the left ureteropelvic junction and caliectatic change, with delayed diodrast excretion was suggestion of renal hydronephrosis due to impacted stone on the ureteropelvic junction. Biopsy specimen following operation this left kidney showed renal tuberculosis and renal calcification.
Cause. Ⅲ
Two radiopaque density on the left kidney and left side of the pelvic region in K. U.B. and loss of function of the left kidney in I. V. P. were indication of impacted left ureteral stone and renal stone. But the left kidney was proved as renal tuberculosis with coincidental renal stone and ureteral stone.

Case. Ⅳ
By retrograde and intravenous pyelograms, the right kidney was thought of having renal tuberculosis, but the left kidney showed caliectatic change above the butterfly -Iike irregular radiopaque density on the upper third of the ureter. Follow-up study after removing this calculus, by urine examinaton obtained from surgery and posto-
perative intravenous pyelograth showed bilateral renal tuberculosis and left renal stone.

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