Obstructive nephropathy requiring dialysis secondary to genitourinary tuberculosis with concomitant pulmonary tuberculosis in an immunocompetent young adult: A case report.
4 affiliations
- 1Department of Internal Medicine, St. Paul's Hospital Hospital Millennium Medical College, Addis Ababa, Ethiopia.
- 2Department of Intensive care Medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
- 3Department of Emergency and Critical Care Medicine Haramaya University, Harar, Ethiopia.
- 4Department of surgery, Urology Division, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Abstract
Background
Genitourinary tuberculosis (GUTB) is a common form of extra-pulmonary tuberculosis that often presents with nonspecific urinary symptoms and is frequently diagnosed late. Genitourinary tuberculosis can cause progressive urinary tract obstruction, hydronephrosis, and renal impairment, particularly when diagnosis is delayed. Concurrent pulmonary involvement may occur and should be considered when evaluating patients with suspected genitourinary tuberculosis.Case presentation
A 39-year-old male presented with a two-year history of progressive lower urinary tract symptoms,later accompanied by hematuria, constitutional symptoms, and altered mentation. Laboratory evaluation revealed severe anemia, elevated inflammatory markers, and progressive acute kidney injury. Abdominal CT demonstrated chronic right renal atrophy with left hydroureteronephrosis with ureteric wall thickening, asymmetric bladder wall thickening, and significant abdominopelvic lymphadenopathy. Urine GeneXpert MTB/RIF was positive for Mycobacterium tuberculosis. Chest radiography and HRCT confirmed concurrent active pulmonary tuberculosis with apical cavitary lesions and tree-in-bud nodules. The patient required hemodialysis for refractory hyperkalemia and uremic encephalopathy. After stabilization, renal-dose antituberculous therapy (RHZE) was initiated the patient showed progressive clinical and renal improvement. He was discharged and continued antituberculous therapy.Conclusion
This case highlights that obstructive uropathy and renal failure may be presenting manifestations of genitourinary tuberculosis even in immunocompetent adults living in high-burden settings. Concurrent pulmonary tuberculosis should therefore be actively investigated. Early use of urine-based molecular testing, such as GeneXpert, together with a high index of suspicion may facilitate timely diagnosis and treatment, potentially preventing irreversible renal and urinary tract damage.
Related
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- Severe Inflammatory Response and Moderate Acute Respiratory Distress Syndrome (ARDS) in an Immunocompetent Patient With Disseminated Tuberculosis: A Case Report.
- Tuberculous Cervical Lymphadenitis (Scrofula) Associated with Massive Pleural Effusion in an Immunocompetent Adult: A Rare Presentation of Extrapulmonary Tuberculosis Confirmed by GeneXpert MTB/RIF.
- A Whole-blood Transcriptional Signature Associated With Obstructive Post-tuberculosis Lung Disease.
- Cachexia and Sarcopenia in Patients with Coexisting Chronic Obstructive Pulmonary Disease and Pulmonary Tuberculosis
BibTeX
@article{ghebremichael2026obstructive,
title = {{Obstructive nephropathy requiring dialysis secondary to genitourinary tuberculosis with concomitant pulmonary tuberculosis in an immunocompetent young adult: A case report.}},
author = {Henok Taddese Ghebremichael and Amanuel Dagabas Wakoya and Mikiyas Wondwesen Ayele and Dagmawi Antneh Teferi and Tadege Haregewoine Alemayehu},
journal = {IDCases},
year = {2026},
month = oct,
doi = {10.1016/j.idcr.2026.e02801},
url = {https://europepmc.org/article/MED/42921387},
note = {CC BY},
}
RIS
TY - JOUR
TI - Obstructive nephropathy requiring dialysis secondary to genitourinary tuberculosis with concomitant pulmonary tuberculosis in an immunocompetent young adult: A case report.
AU - Henok Taddese Ghebremichael
AU - Amanuel Dagabas Wakoya
AU - Mikiyas Wondwesen Ayele
AU - Dagmawi Antneh Teferi
AU - Tadege Haregewoine Alemayehu
PY - 2026
DA - 2026/10/14
JO - IDCases
DO - 10.1016/j.idcr.2026.e02801
UR - https://europepmc.org/article/MED/42921387
AB - Background Genitourinary tuberculosis (GUTB) is a common form of extra-pulmonary tuberculosis that often presents with nonspecific urinary symptoms and is frequently diagnosed late. Genitourinary tuberculosis can cause progressive urinary tract obstruction, hydronephrosis, and renal impairment, particularly when diagnosis is delayed. Concurrent pulmonary involvement may occur and should be considered when evaluating patients with suspected genitourinary tuberculosis.Case presentation A 39-year-old male presented with a two-year history of progressive lower urinary tract symptoms,later accompanied by hematuria, constitutional symptoms, and altered mentation. Laboratory evaluation revealed severe anemia, elevated inflammatory markers, and progressive acute kidney injury. Abdominal CT demonstrated chronic right renal atrophy with left hydroureteronephrosis with ureteric wall thickening, asymmetric bladder wall thickening, and significant abdominopelvic lymphadenopathy. Urine GeneXpert MTB/RIF was positive for Mycobacterium tuberculosis. Chest radiography and HRCT confirmed concurrent active pulmonary tuberculosis with apical cavitary lesions and tree-in-bud nodules. The patient required hemodialysis for refractory hyperkalemia and uremic encephalopathy. After stabilization, renal-dose antituberculous therapy (RHZE) was initiated the patient showed progressive clinical and renal improvement. He was discharged and continued antituberculous therapy.Conclusion This case highlights that obstructive uropathy and renal failure may be presenting manifestations of genitourinary tuberculosis even in immunocompetent adults living in high-burden settings. Concurrent pulmonary tuberculosis should therefore be actively investigated. Early use of urine-based molecular testing, such as GeneXpert, together with a high index of suspicion may facilitate timely diagnosis and treatment, potentially preventing irreversible renal and urinary tract damage.
SN - 2214-2509
ER -