Preliminary exploration of Kub stage classification and treatment of clinical renal tuberculosis
Objective To investigate the Kub stage classification of clinical renal tuberculosis and provide a reference for disease evaluation and management.Methods A retrospective analysis was conducted on clinical data from 180 patients diagnosed with renal tuberculosis who were admitted to the First Affiliated Hospital of Dali University between January 2011 and December 2022.The 180 cases included 82 males and 98 females.The average age was(44.56±9.62)years.The tuberculosis lesions of 101 cases were on left kidney,while that of 79 cases were on right kidney.Localized/multiple lesions were observed in 118 cases,whereas extensive destruction was found in 62 cases.Moreover,the ureters were involved in 165 cases,and bladder invasion occurred in 139 cases.For patients undergoing renal preservation treatment,a comprehensive approach was employed,including ureteral stricture stenting and regular replacement of double-J stent,percutaneous nephrostomy,excision of tuberculosis lesions or partial nephrectomy,ureter reconstruction,and sigmoidocystoplasty.In cases requiring nephrectomy,either laparoscopic or open surgical approaches are utilized.Based on the results of patient imaging and endoscopy,staging and classification were performed based on the extent of tuberculosis lesions involving the kidneys(K),ureters(u),and bladder(b).The state for each above organ was divided into four stages:K stage(K1-4),u stage(u0-u3),and b stage(b0-b3),which were then combined with the actual disease condition for further categorization.The classifications included local intrarenal type(K1-2u0b0),local renal-ureteral involvement type(K1-2 u1-2 b0-2),multiple renal-ureteral invasion type(K3 u1-3 b0-2)and extensive destruction type(K4u1-3b1-3).Further analysis was conducted on kidney preservation and subsequent disease progression among patients with different subtypes.Results Among the 180 patients,15 cases of local intrarenal type underwent kidney-preserving treatment.Out of these cases,6 patients(4 patients in stage K1 u0 b0 and 2 patients in stage K2b u0 b0)achieved clinical cure after receiving a pure durative anti-tuberculosis for two years.Additionally,4 patients in stage K2a u0 b0 attained clinical cure following anti-tuberculosis drugs combined with partial nephrectomy after two years of follow-up.Furthermore,5 patients in stage K2b u0 b0 underwent ureteroscopy and D-J stent placement for regular stent replacement.The stents were subsequently removed after two years,and the patients remained clinically stable.Among the 47 cases with localized renal-ureteral involvement type,all initially underwent kidney-preserving treatment.Of these,5 patients in stage K1 u1 b0-2 achieved clinical remission,while disease progression necessitated nephrectomy for 3 patients in stage K2au1-2b0-2 and 7 patients in stage K2bu1-2b0-2.The remaining patients maintained stable conditions.Among the 56 cases of multiple renal-ureteral invasion type,stable conditions were observed in 9 out of 24 patients with stage K3u1-2b0-2,while disease progression necessitated nephrectomy in 15 cases.Nephrectomy was performed for all 32 patients with stage K3u3b0-2.In instances of extensive destruction type,nephrectomy was conducted for all 62 cases.The progression rates of the local renal-ureteral involvement type and the multiple renal-ureteral invasion type were 21.28％(10/47)and 48.39％(15/31),and the difference was statistically significant(P＜0.05).The kidney preservation rates of the local renal-ureteral involvement type and multiple renal-ureteral invasion type were 78.72％(37/47)and 16.07％(9/56),and the difference was statistically significant(P＜0.001).Conclusions The Kub stage classification can provide reference to management and monitoring for renal tuberculosis.The patients in the local intrarenal type and local renal-ureteral involvement type are often treated with anti-tuberculosis plus ureteral stent implantation or partial nephrectomy or ureteral reconstruction.The patients in the multiple renal-ureteral invasion type and extensive destruction type are mostly managed by nephrectomy.
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