End-stage Renal Disease Caused by Paradoxical Response and Subsequent Bacterial Infection in Urinary Tract Tuberculosis: a Case Report

Tuberculosis of urinary tract seldom progress to End-stage renal disease (ESRD). It``s because tuberculosis responds well to pharmacological treatment. Nevertheless, urinary tract tuberculosis can worsen paradoxically if treatment is started in far-advanced stage. Several case reports suggest that vitamin D deficiency or interferon-γ dysfunction may promote progression to ESRD in urinary tract tuberculosis. Urinary tract tuberculosis is frequently combined with bacterial infections. It is not a serious problem in usual case but, recurrent bacterial coinfection can cause progression to ESRD in far-advanced urinary tract tuberculosis. We describe a case of ESRD caused by urinary tract tuberculosis combined with recurrent bacterial infections. A 53-year-old woman to have been considered bacterial urinary tract infection was diagnosed finally with urinary tract tuberculosis. She had been maintaining percutaneous nephrostomy catheters in both kidneys. The patient progressed to ESRD although an appropriate anti-tuberculosis medication has been prescribed for 4 months. At the time of starting renal replacement therapy, the patient was suffering from sepsis caused by the bacterial urinary tract infection. New tuberculosis lesions were then developed in the lumbar spine and psoas muscle. We suggest that urinary tract tuberculosis could progress to ESRD if it is diagnosed in far-advanced stage and followed by subsequent recurrent bacterial urinary tract infection and paradoxical response against anti-tuberculosis treatment.