Unusual ureteral stenosis in an immunosuppressed patient

A case report.

Abstract

Introduction: Genitourinary tuberculosis (GUTB) is one of the most insidious forms of extrapulmonary tuberculosis. In patients living with HIV, progression toward structural complications can be severe, even under stable immunological control. This report aims to analyze the clinical course of GUTB leading to end-stage renal disease (ESRD) secondary to obstructive nephropathy.

Case Report: A 45-year-old male patient with a 15-year history of HIV (undetectable viral load and CD4+ > 250 cells/mm³) and a recent history of successfully treated pulmonary tuberculosis. He presented with a 3-month history of dysuria and progressive decrease in urinary volume, evolving into acute urinary retention. Imaging revealed Grade IV bilateral hydronephrosis and segmental ureteral stenosis. Laboratory tests showed critical impairment of renal function (initial creatinine of 3 mg/dL, progressing to 19.27 mg/dL, and urea of 284 mg/dL). Urine culture confirmed the presence of Mycobacterium tuberculosis.

Outcome: Despite the initiation of antitubercular treatment and bladder decompression, the patient developed severe uremic symptoms. The severity of the bilateral obstructive nephropathy resulted in irreversible renal damage (Stage V), requiring the initiation of chronic renal replacement therapy (dialysis). Surgical resolution was not feasible due to the extent of the fibrosis.

Conclusion: Genitourinary tuberculosis can cause accelerated end-stage renal failure due to obstructive nephropathy, even in patients with controlled HIV and successful antitubercular treatment. Irreversible ureteral fibrosis demands early urological monitoring to detect strictures before functional damage becomes permanent and requires chronic dialysis.