This document discusses the case of a 55-year-old male patient who presented with hypertension. His medical history includes tuberculosis treatment 35 years ago. Examination shows elevated blood pressure. Imaging from 3 years ago shows possible renal calculi. The document then discusses "putty kidney", a radiological sign of renal tuberculosis, and other imaging features of renal TB. It also covers causes of renal calcification and investigations for genitourinary tuberculosis. Treatment involves antitubercular therapy and sometimes nephrectomy.

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
A. Dystrophic calcification due to localised disease:
Usually one kidney or part of one kidney.
 Infections :
1. Tuberculosis
2. Hydatid disease
3. Xanthogranulomatous pyelonephritis
4. Abscess
 Carcinoma
 Aneurysm of renal artery

10. Contd . . .
B. Nephrocalcinosis
C. Medullary :
1. Hyperparathyroidism
2. RTA
3. Medullary Sponge Kidney
4. Renal papillary necrosis
5. Causes of hypercalcemia or hypercalciuria
6. Preterm infants
7. Primary hyperoxaluria
D. Cortical :
1. Acute cortical necrosis
2. Chronic glomerulonephritis
3. 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?

16. THANK YOU