Be alert to tuberculosis-mediated glomerulonephritis: a retrospective study

Abstract

Mycobacterium tuberculosis infection causing glomerulonephritis is a rare disorder. This retrospective study analyzed the clinical characteristics of patients diagnosed with tuberculosis-mediated glomerulonephritis (TB-GN) between 2002 and 2009, as well as the diagnostic tools used. These findings were then compared with those of patients with primary glomerulonephritis (P-GN). The records of all patients were reviewed. The diagnosis of TB-GN was based on renal hematuria and/or proteinuria and cure after antituberculosis therapy alone plus urine culture positive for M. tuberculosis, demonstration of typical tubercle granulomas on renal biopsy specimens, or the detection of M. tuberculosis DNA by polymerase chain reaction (PCR) on renal specimens. Forty-six patients with TB-GN and 49 patients with P-GN were included. Compared with patients in the P-GN group, most (76%) patients with TB-GN had a history of TB. Systemic symptoms were much more frequent in patients with TB-GN than local genitourinary symptoms. Serological testing showed a statistical difference between the two groups. Immunoglobulin A nephropathy was found in the majority (72%) of patients with TB-GN. M. tuberculosis DNA detection was positive in 39 (84.8%) patients, a much higher positive rate of diagnosis than that with urine culture for M. tuberculosis. The manifestation of TB-GN is atypical and nonspecific. It warrants a high index of suspicion when patients with renal hematuria and proteinuria fail to respond to standard treatments for P-GN. Clinicians should pay close attention to the medical history and results of special laboratory tests. M. tuberculosis DNA detection on renal biopsy specimens should be considered in order to confirm the diagnosis of TB-GN.

Tuberculosis-associated IgA nephropathy

“…According to a previous study, 43 patients who meet the following criteria can be diagnosed with TB-IgAN: (1) evidence of MTB infection, (2) elevated serum levels of a specific circulating immune complex in TB and reduced serum complement component 3 levels, (3) clinical manifestation of renal involvement, (4) renal pathological changes that are consistent with IgAN and exclude renal TB, (5) exclusion of secondary IgAN, and (6) MTB -specific antigen deposition in renal tissues.…”

“…MTB DNA detected by polymerase chain reaction in renal biopsy specimens has a considerably increased positive rate compared with that found with urine culture. 43 Therefore, MTB DNA detection in renal biopsy tissues could be used to verify the diagnosis of TB-IgAN. A current study also showed that ESAT-6 could assist in the early diagnosis of IgAN caused by MTB infection.…”

Clinical Features and Drug-Resistance Profile of Urinary Tuberculosis in South-Western China

“… 24 Sun et al found that DNA-extraction steps could cause a substantial loss of mycobacterial DNA. 25 However, our findings still indicate that real-time PCR is an instant and effective diagnostic tool for suspected UTB patients. Although DNA does not replace conventional diagnostic tests completely, it is an indispensable complement.…”

Curious case of fever of unknown origin

“…The classical presentation involving the urinary collecting system is usually diagnosed on microbiological and radiological investigations. Isolated renal parenchyma involvement, including interstitial nephritis and glomerulonephritis, is uncommon, and there is sparse literature on the utility of renal biopsy in these patients 18…”