Serologic and urinary characteristics of laboratory-confirmed genitourinary tuberculosis at a tertiary hospital in the Philippines

(2021) 21:125 So and Villanueva BMC Urol https://doi.org/10.1186/s12894-021-00888-3 Open Access RESEARCH Serologic and urinary characteristics of laboratory‑confirmed genitourinary tuberculosis at a tertiary hospital in the Philippines Paolo Nikolai H. So* and Anthony Russell T. Villanueva Abstract Background: Genitourinary tuberculosis (GUTB) is known to cause high rates of structural organ damage, however, literature on its biochemical manifestations is limited. Additionally, local studies in the Philippine setting, where cases are rampant, are few and dated. This study aimed to determine the serologic and urinary profile of patients with GUTB admitted at a tertiary hospital within January 2009 to March 2020 and their association with short-term outcomes. Methods: This retrospective study included 112 patients with laboratory-confirmed GUTB (i.e., positivity in acid-fast smear, polymerase chain reaction, culture, or histology). Demographic data, clinical characteristics, laboratory and radiologic findings, histopathology reports, treatment, and short-term outcomes were recorded. Results: Bladder (54.5%) and kidney (36.4%) were the most affected organs. The male:female ratio was 1:1.15, and the mean age was 35.79 ± 18.29 years. Weakness (14.29%) was the most common chief complaint. A majority presented with anemia (83.04%), while several had leukocytosis (41.96%) and thrombocytosis (26.79%). Hypoalbuminemia (58.10%), impairment of renal function (36.94%), and electrolyte abnormalities such as hyponatremia (50.93%), hypercalcemia (20.19%), and hypokalemia (21.82%) were common. Proteinuria (67.96%) and pyuria (67.96%) were the most frequent abnormal findings, followed by hematuria (51.46%), acidic urine (45.63%) and low specific gravity (31.07%). Age, leukocytosis, and the need for pressors were all significantly associated with mortality (p values of <0.001, 0.010, and <0.001, respectively). Conclusions: The young age at presentation with severe clinical and laboratory manifestations may reflect local epidemiology as TB continues to be widespread in the country. Apart from the more commonly cited abnormalities in literature, multiple electrolyte imbalances and urinary concentration defects were also observed in many cases, possibly indicating tubulointerstitial involvement—a complication increasingly mentioned in case reports. As several patient characteristics were found to be associated with the high mortality rates observed in the study, further research is recommended to explore predictive modeling. Keywords: Genitourinary tuberculosis, Electrolytes, Urinalysis, Association *Correspondence: Division of Nephrology, Department of Medicine, University of the Philippines Manila – Philippine General Hospital, Taft Avenue, Ermita, 1000 Manila, Philippines Introduction Tuberculosis (TB) remains an important global epidemic, with latest estimates of disease burden amounting to 10.0 (range, 9.0–11.1) million people in 2018 [1]. Extrapulmonary TB (EPTB) is reported to comprise © The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. So and Villanueva BMC Urol (2021) 21:125 around 16.5–25% of all cases, attributing 4.5–27% to genitourinary TB (GUTB) [2–4]. GUTB historically pertains to the infection of the urogenital system organs in any combination by Mycobacterium tuberculosis (MTB) or Mycobacterium bovis [5–8]. It presents with insidious and late-onset symptoms, making its diagnosis and treatment difficult and delayed, and consequently leading to high rates of structural organ damage and kidney failure [9, 10]. Some physicians advocate the term urogenital TB (UGTB) as kidney TB is the most relevant infection and is more frequently diagnosed than genital TB [5, 6, 11]. Philippines ranked 4th among the countries with high TB burden in 2018, accounting 6% of the global total. It has a TB incidence rate of 554 (311–866) per 100,000 population, and a mortality rate of 24.57 (20–32) per 100,000 population [1]. This high disease prevalence in the country is multifactorial, attributing to high poverty rate, marked social inequities, and rise in slum housing and crowded living conditions from rapid urbanization [12]. In the Filipino pediatric population, GUTB is found to cause 3% of extrapulmonary TB cases admitted in a tertiary hospital [13]. Despite these figures, there is paucity in literature regarding local experience on GUTB, especially with regards to serologic and urinary findings [14–16]. The last available reference was published 25 years ago, which also needs to be updated. The study aims to determine the serologic and urinary profile of patients with genitourinary TB admitted at a tertiary government hospital in Philippines and their association with short-term outcomes. Methods Study design and population This is a single-center, retrospective study performed at the Philippine General Hospital (PGH; 1500 beds). This study included GUTB patients diagnosed from January 2009 to March 2020 through positivity in at least one of the following: (1) urine acid-fast bacilli (AFB) staining, (2) urine or tissue polymerase chain reaction (PCR) for Mycobacterium tuberculosis, (3) urine or tissue M. tuberculosis culture, and (4) histologic findings of granulomatous inflammation (granulomas composed of epithelioid cells and Langhans giant cells with or without caseous necrosis) [14, 15, 17–19]. Culture-positive samples solely involving the female genital tract without urologic involvement, out-patients, in-patients without baseline serologic and urinary tests, and those who got discharged against medical advice were excluded. This study Page 2 of 34 was approved by the University of the Philippines Manila Research Ethics Board and the requirement for informed consent was waived since the investigators evaluated anonymized data. Data collection and definition of variables Data collection was done through chart review of patient medical records. This included (...truncated)