Tuberculosis and Chronic Renal Disease

Abstract

There is an increased risk (6.9- to 52.5-fold) of tuberculosis (TB) in patients with chronic renal failure and on dialysis as compared to the general population. The symptomatology in renal patients is often insidious and nonspecific, mimicking uremic symptoms, whereas the localization is often extrapulmonary (most frequently tuberculous lymphadenitis and peritonitis). Tuberculous peritonitis makes up a large part (37%) of the total number of TB cases in continuous ambulatory peritoneal dialysis (CAPD) patients. The prognosis is very much dependent on early diagnosis and treatment. Renal physicians should be aware of the unusual presentation and localization, and include TB in the differential diagnosis of any patient having nonspecific symptoms like anorexia, fever, and weight loss. All efforts should then be made (including invasive investigations) to reach an early diagnosis, a major determinant of the outcome. However, if this is not possible or the result is negative and the diagnosis remains strongly suspected, an empirical trial with anti-TB medication is justified, especially in endemic areas. In view of the increased prevalence of the disease in the dialysis population, TB prophylaxis is recommended in those patients with a positive tuberculin (Mantoux) skin test and radiographs suggestive of old TB.

Características clínicas e evolução de pacientes imunocomprometidos não HIV com diagnóstico intra-hospitalar de tuberculose

“…patients with chronic renal failure, nonspecific symptoms and a common extrapulmonary presentation can be risk factors for delayed diagnosis. (21) One group of authors also described the atypical presentation of pulmonary TB in patients with diabetes. (22) Among the patients with diabetes included in our study, a history of weight loss was less common.…”

Active Tuberculosis in Patients Undergoing Hemodialysis for End-stage Renal Disease: A 9-year Retrospective Analysis in a Single Center

“…Patients with end-stage renal disease (ESRD) have a higher (6.9-to 52.5-fold) risk of tuberculosis (TB) than the general population (1). While some studies have reported a high mortality rate of 17-75% in uremic patients with TB (2,3), several have reported a very favorable outcome, with no mortality, which may be attributed to both an early diagnosis and treatment (4,5).…”

Prevalence of latent tuberculosis and treatment adherence among patients with chronic kidney disease in Campo Grande, State of Mato Grosso do Sul

“…Decades later, another study showed a signifi cantly increased risk of TB in patients with chronic renal failure who were undergoing dialysis 18 . In cohort studies, the relative risk of TB among such patients was 3.4 to 25.3 times greater than that among the general population [19][20][21][22] .…”