Khaira Ambar, Bagchi Soumita, Sharma Alok, Mukund Amar, Mahajan Sandeep, Bhowmik Dipankar, Dinda Amit K, Agarwal Sanjay K
Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India.
Department of Pathology, 1st Floor Teaching Block, All India Institute of Medical Sciences, New Delhi, 110029, India.
Clin Exp Nephrol. 2009 Aug;13(4):392-396. doi: 10.1007/s10157-009-0158-6. Epub 2009 Mar 17.
Renal transplant recipients are prone to a variety of infections due a persistent immunodepleted state. Incidence of tuberculosis in this population is much higher compared with the general population. While pulmonary tuberculosis still remains the commonest form in this population, renal allograft tuberculosis is very rare. We report two cases of isolated allograft tuberculosis and one case of allograft tuberculosis with coexistent pleuro-pulmonary and bone marrow involvement. All three cases had presented with pyrexia of unknown origin, wherein despite extensive investigations the cause was not found. In two cases the diagnosis was confirmed on histology. Two cases responded to non-rifampicin-based modified antitubercular treatment and one to conventional four-drug Rifampicin-based regimen. Graft function improved in two cases while in one case the graft was lost. Tuberculosis involving the renal allograft is a potential cause for graft dysfunction/loss and requires a high index of suspicion for diagnosis. Timely detection and early institution of therapy can help save the renal allograft.
由于持续的免疫耗竭状态，肾移植受者容易发生各种感染。该人群中结核病的发病率比普通人群高得多。虽然肺结核在该人群中仍然是最常见的形式，但肾移植结核非常罕见。我们报告了2例孤立性移植肾结核病例和1例合并胸膜肺及骨髓受累的移植肾结核病例。所有3例均表现为不明原因发热，尽管进行了广泛检查仍未找到病因。2例经组织学确诊。2例对基于非利福平的改良抗结核治疗有反应，1例对基于利福平的传统四联疗法有反应。2例移植肾功能改善，1例移植肾丢失。累及移植肾的结核是移植肾功能障碍/丧失的潜在原因，诊断需要高度怀疑。及时检测和早期治疗有助于挽救移植肾。
