October - LRS Institute of Tuberculosis & Respiratory Diseases

A CORRELATIVE STUDY ON ISOTOPE RENOGRAPHY, INTRAVENOUS
PYELOGRAPHY AND URINE CULTURES POSITIVE FOR MYCOBACTERIUM
TUBERCULOSIS IN TUBERCULOUS PATIENTS
P.K. MUKHERJI, 1 K.D. VERMA;, 2 S.K. AGARWAL AND R. PRASAD 3
Summary : Urine specimens from patients of pulmonary tuberculosis (100 patients) and osteoarticular
tuberculosis (50 patients) were submitted routinly for mycobacterial cultures. 16 patients
(10.7%) were found to have positive urine culture for M. tuberculosis. Isotope renography depicted
abnormalities of various types in 13 (81.2%) patients, while I.V.P. indicated abnormalities only in 7
(43.7 %) patients. It was evident that isotope renogram is a much better marker to defect renal involvement.
In 7 patients (4.6%) a positive urine culture for M. tuberculosis was not anticipated, and in 3
patients isotope renograms and I.V.P. were also normal. Thus normal symptoms or normal tests
do not necessarily exclude the possibility of genito-urinary tuberculosis.
Introduction
Tuberculosis bacilluria is known to be
associated with tuberculosis of various sites of
the body and many workers believe that renal
tuberculosis can exist without clinical manifestations
(Hobbs, 1923; Medlar, 1926; Medlar
Spain and Holliday, 1949; Wechsler, West fall
and Lattimer, 1960; Bentz et al 1975). In the
present work we have tried to determine the
frequency of this occurrence and to correlate the
positive urine cultures for Mycobacterium tuberculosis
with isotope renography and intravenous
pyelography,
Material and Methods
100 bacteriologically confirmed patients of
pulmonary tuberculosis and 50 patients of osteoarticular
tuberculosis were included in the study.
Basis of diagnosis in the latter group was
clinical and radiological evidence with a positive
tuberculosis reaction. Following specific
investigations were conducted:—
(a) Urinalysis and routine urine culture for
Mycobacterium tuberculosis was done
in all patients.
(b) Isotope renography was performed in
those patients where urine culture was
positive for mycobacterium tuberculosis.
(c) Intravenous pyelography was performed
in those patients, where urine culture
was positive for mycobacterium tuber
culosis.
(b) Urine Culture for Mycobacterium
Tuberculosis
All drugs were discontinued for at least 5
days prior to collection of urine. Early morning,
first voided urine specimens of all the patients
were submitted for mycobacterial culture
(Kenny, Loechel and Lovelock I960; Agarwal,
Srivastava and Prasad 1981). Cultures were
done under strict sterile condition on Lowenstein
—Jensen media by Petroff’s concentration
technique (Cruickshank 1975). The media were
incubated in an incubator at a temperature of
37°C for a period of 6 to 8 weeks. Mycobacterium
tuberculosis was identified by typical
colony morphology and bio-chemical test
(Cruickshank 1975).
(b) Isotope Renography
Isotope renography was done according to
the standard method (Witcofski et al 1961).
Site of kidney was localised earlier by a plain
X-ray abdomen or by an intravenous pyelogram.
After proper preparation of the patients,
I- 131 Hippuran (Orthoiodo hippuric Acid). 25
uci/Kg. body weight was injected rapidly by
intravenous route. Isotope renogram charts
were obtained and analysed for any abnormal
findings.
Qualitative analysis was done according to
the criteria of Kennedy et al (1965). Renograms
were classified into unilateral or bilateral
abnormalities and were grouped into three
types :—
(1) Flattening of all the phases suggesting
parenchymal damage (Type A).
(2) Flattening of secretory phase, lowered
somewhat delayed peak, indicating
impaired vascular and tubular functions
(Type B).
1. Department of Tuberculosis
2. Department of Surgery
3. Department of Pathology and Bacteriology, King George’s Medical College, Lucknow
Ind. J. Tub., Vol. XXIX, No. 4