Renal subcutaneous nodule (tuberculosis of the kidney) may be part of systemic miliary subcutaneous nodules. After subcutaneous nodule bacteria enter the bloodstream, both kidneys are usually affected simultaneously. There are no clinical symptoms in the early stages. If the condition is not controlled and progresses from the glomeruli to the inner layers of the kidney, it can quickly spread to the ureter and bladder, leading to a series of clinical symptoms such as frequent urination, urgency, dysuria, and hematuria. It is rare in children.

bubble_chart Clinical Manifestations

1. Chronic bladder inflammation symptoms include frequent urination, urgency, dysuria, hematuria, pyuria, etc., mostly terminal hematuria with blood clots in the urine.
2. Dull pain in the affected side of the waist; if the ureter is blocked by blood clots or caseous material, renal colicky pain occurs. In severe cases, a mass may be palpable in the renal region.
3. It is often accompanied by other subcutaneous node lesions, such as in the lungs, bones, or lymph nodes.

bubble_chart Auxiliary Examination

1. Urinalysis shows protein, common bletilla tuber, red blood cells, and pus cells; in severe cases, gross hematuria and pyuria may be present. A 24-hour urine collection can be centrifuged, and the sediment smear may reveal subcutaneous node bacteria. If necessary, culture or animal inoculation can be performed.
2. Erythrocyte sedimentation rate (ESR) is increased. 3. OT or PPD test is positive.

   X-ray examination

   1. Abdominal plain film shows enlarged kidney outline, occasionally with calcification shadows.

3. Intravenous pyelography reveals blurred renal pelvis and calyces, with irregular or defective calyceal margins.
4. Cystoscopy can be performed for undiagnosed cases to directly observe bladder lesions. It allows separate examination of urine and renal function from both sides and can also be used for retrograde pyelography, which provides clearer visualization of the renal pelvis and calyces morphology.

bubble_chart Treatment Measures

(1) Conservative Treatment

1. Anti-subcutaneous node drugs: For early-stage mild cases with no severe destruction of the renal pelvis and calyces, anti-subcutaneous node drugs can achieve a cure. During drug therapy, regular monitoring of treatment response is necessary, including weekly routine urine tests and intravenous pyelography every 4–6 months to observe renal pelvis lesions and detect any ureteral stenosis. For cases with poor response, the treatment plan should be promptly adjusted without delaying surgical intervention. Three-drug combination: The usage, dosage, and principles for starting/stopping medication are the same as for primary pulmonary subcutaneous node. (1) INH + EBM + SM: - INH: 1–1.5 years; - EBM: 9–12 months; - SM: After 1–2 months, switch to three times per week for 3–6 months. (2) INH + RFP + SM: - INH: 1–1.5 years; - RFP: 9–12 months; - SM: After 1–2 months, switch to three times per week for 3–6 months.
2. General therapy: Bed rest is recommended, preferably with hospitalization, along with enhanced nutrition and multivitamin supplementation.

1. Unilateral extensive sexually transmitted disease involvement with normal contralateral kidney function.
2. Bilateral lesions, where one side is severely damaged and nonfunctional while the other side has milder lesions—after a period of drug therapy, the severely affected side may be resected.
3. Unilateral renal subcutaneous node with extensive calcification (referred to as "auto-nephrectomy") may also be surgically removed.
4. Severe unilateral renal pelvis or ureteral lesions that impair kidney function or lead to secondary infection.

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1. If other organ subcutaneous node involvement is present, anti-subcutaneous node therapy should be administered for 3 months before surgery, with the procedure performed once the general condition stabilizes.
2. For isolated renal subcutaneous node, anti-subcutaneous node drugs should also be administered for 1–2 weeks preoperatively.
3. After nephrectomy, anti-subcutaneous node drug therapy should continue for at least 6–12 months.

bubble_chart Differentiation

1. Chronic pyelonephritis presents with bladder irritation symptoms, which may include hematuria and pyuria. It tends to recur with varying severity, and general antibiotic treatment shows some efficacy. Bacteriological examination can aid in differentiation. Bladder inflammation caused by renal subcutaneous nodules is persistent, unresponsive to general antibiotics, and progressively worsens.
2. Among pediatric urological tumors, nephroblastoma (Wilms' tumor) is common, manifesting as painless hematuria with minimal bladder irritation symptoms. An abdominal mass is often palpable, and no subcutaneous nodule bacteria are found in the urine.
3. For renal subcutaneous nodules with ureteral colicky pain, differentiation from ureteral stones is necessary. Plain abdominal radiography can reveal stone images. The urine primarily contains red blood cells, with no subcutaneous nodule bacteria detected. There are no subcutaneous nodule-related toxic symptoms.