Limitation of Chemotherapy in Advance Cavitary Tuberculosis of the Kidney

Our plain-English summary of Limitation of Chemotherapy in Advance Cavitary Tuberculosis of the Kidney, by M. Malament, O. Auerbach, J.T. Harris (1968).

The study

• Authors: M. Malament, O. Auerbach, J.T. Harris
• Published: Journal of Urology , Volume 99. June 1968
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library. The article is still under copyright, so we describe it here rather than post it.

In plain English

This 1968 article is not about asbestos. It is a series of four case reports on advanced cavitary tuberculosis of the kidney, from the Veterans Administration Hospital in East Orange and Perth Amboy General Hospital in New Jersey. All four patients were started on triple drug therapy (streptomycin, isoniazid (INH) and para-aminosalicylic acid (PAS)), though the second patient could not tolerate PAS, and each later had the diseased kidney removed. In the first patient, a 52-year-old man, surgery came after 16 months of therapy. Culture of the removed kidney showed no growth of acid-fast bacilli, yet microscopy showed tuberculous granulation tissue. The authors reported signs of healing in all four kidneys, but active disease was still found on microscopy. A culture from the kidney in case 3, which showed the most advanced healing, was positive for acid-fast organisms. Multiple micro-abscesses were found in the first three cases. The authors attributed the persistence to an obliterating endarteritis that kept circulating drugs from reaching all infected areas. They concluded that in the advanced destructive phase, serious consideration should be given to surgery.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report series (4 cases) with discussion
• Who was studied: Four patients with advanced renal tuberculosis seen at the Veterans Administration Hospital, East Orange, New Jersey, and Perth Amboy General Hospital, Perth Amboy, New Jersey, treated roughly 1961 to 1964. The patients were a 52-year-old white man, a 23-year-old Negro patient, a white woman whose age is unreadable in the scan, and a 72-year-old white man.
• Exposure: Not asbestos. The exposure was anti-tuberculosis triple drug therapy with streptomycin, isoniazid (INH) and para-aminosalicylic acid (PAS), followed by surgical removal of the kidney. The patient in case 2 could not tolerate PAS. The printed doses appear damaged by scanning and are not repeated here.
• Main results:
  • Case 1: right nephroureterectomy was performed after 16 months of therapy.
  • Case 1: culture of material from the pelvis of the excised kidney showed no growth of acid-fast bacilli.
  • Case 1: on microscopy, the cavity was surrounded by tuberculous granulation tissue.
  • Case 2: the patient was placed on triple drug therapy and continued to take streptomycin, but was unable to tolerate PAS.
  • Across the four cases, evidence of active disease was found on microscopy of the excised kidneys.
  • Across the four cases, the histopathology showed evidence of anatomic healing in each case.
  • Case 3: the kidney showing the most advanced healing gave a culture positive for acid-fast organisms.
  • In the first 3 cases, multiple micro-abscesses containing purulent exudate were found throughout the kidney.
  • The authors attributed persisting active infection to an obliterating endarteritis caused by tuberculous granulation tissue, which kept some areas from being exposed to the circulating drugs.
• The authors' conclusion: The authors concluded that chemotherapy has proven effective in early lesions, but that in the advanced destructive phase serious consideration should be given to surgical intervention.

Topics

Medical terms in this study, explained in our Lexicon: Chemotherapy.

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