Ways to treat mephrotuberculosis(renal tuberculosis)

Condition analysis:
1. Patients are treated initially with four drugs, Isoniazid, Rifampicin, Pyrazinamide and Ethambutol for 2 months to kill most of the bacteria. This is followed by treatment with two drugs, isoniazid and rifampicin for a further period of 4 months to kill persisting bacteria.

2. Directly observed treatment (DOT), where the medication is taken in front of a healthcare worker, is recommended to ensure that the patients take their medication regularly

3. Patients with multidrug resistance receive treatment with second-line drugs for a longer duration, usually with an initial phase of 8 months followed by a maintenance phase of around 12 months

4. In patients with reduced kidney function, the dose of ethionamide, if used, should be reduced. Streptomycin should not be used in these patients

5. In patients with HIV, rifabutin is given instead of rifampicin since rifampicin has a high risk of adverse effects. The treatment is also prolonged for a period of 9 months

Instructions:
Pathology: Renal infection results from haematogenous spread at the time of primary infection, with multiple micro-abscesses developing at the site of periglomerular capillary seeding. Normal host immunity is usually able to dampen the disease with the usual development of a small inactive granuloma.

Usually there is a long latency between primary infection and presentation which in most case occurs due to host immunity becoming compromised. These quiescent granulomas then can reactivate, grow and eventually communicate with the calyces, leading to downstream infection.