Glomerulonephritis associated with tuberculosis: A case report and literature review

Abstract

Rapidly progressive glomerulonephritis caused mycobacterium tuberculosis is rare; however, three case have been reported to date. Crescentic glomerulonephritis is a life-threatening disease and together with the presence of tuberculous infection is associated with a poor outcome if treatment is inadequate and delayed. We describe the case of a 31-year-old female patient with nephrotic syndrome and progressive renal failure secondary to pulmonary tuberculosis. Renal biopsy showed crescent formation in 14 out of 27 glomeruli, and there was diffuse linear staining of immunoglobulin G deposits. Treatment included corticosteroids in combination with antituberculosis drugs for 2 months, and resulted in a significant improvement in renal function, the disappearance of proteinuria and pulmonary symptoms. We also present a review of the pertinent literature and discuss the pathophysiology of tuberculosis-related acute postinfectious glomerulonephritis.

Early Diagnosis of Tuberculosis-Associated IgA Nephropathy with ESAT-6

“…Furthermore, the average gray values were significantly different among three groups, indicating that IgA1 might also serve as a biomarker for the RTB diagnosis. Due to its role in humoral immune system, acute MTB infection is correlated with a marked increase in serum IgA levels, which includes the presence of IgA antibodies against A-60 mycobacterial antigen, IgA immune complexes and mycobacterial antigens in the serum of patients with active TB (Solak et al 2013). Deposition of these complexes in turn may activate the alternative complement and the lectin pathway (Roos et al 2006), with resultant local injuries leading to IgA nephropathy.…”

“…Patients may experience glomerular disease, having advanced renal failure rather than symptoms of classic renal TB sometimes (Hsieh and Wen 2012;Liu et al 2013;Solak et al 2013;Waikhom et al 2014). Furthermore, some IgAN patients should be treated with hormone and immunosuppressant, which may lead to the spread of TB and the deterioration of renal function (Bini et al 2014).…”

Tuberculosis and pauci-immune crescentic glomerulonephritis

“…Only rarely has an association between c-GN and M. tuberculosis been described. Three of these cases revealed an immune complex-mediated pattern of injury (granular immunofluorescence staining),5–7 and the forth revealed an anti-GBM pattern of injury (diffuse linear immunofluorescence staining) 8…”

“…In adults, rapidly progressive glomerulonephritis (RPGN), due to crescentic glomerulonephritis (c-GN), usually occurs in the context of an antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) 2. The unfortunate coincidence of TB and c-GN in the same patient has been described in association with rifampicin,3 4 immune complex-mediated glomerulonephritis5–7 and antiglomerular basement membrane disease 8. Furthermore, TB has been associated with extrarenal manifestations of AAV9 and ANCA-negative leucocytoclastic vasculitis 10.…”

Membranous Nephropathy Associated with Tuberculosis

“…To the Editor: Glomerulonephritis (GN) due to Mycobacterium tuberculosis (M. tuberculosis) is rare,[ 1 ] and membranous nephropathy (MN) associated with tuberculosis is seldom reported. [ 2 ] Because of atypical and nonspecific manifestations, tuberculosis-associated GN (TB-GN) is difficult to diagnose.…”