Renal Unit, Barts and the London NHS Trust, London, UK.
Renal Unit, Barts and the London NHS Trust, London, UK.
Kidney Int. 2011 Mar;79(6):671-677. doi: 10.1038/ki.2010.482. Epub 2010 Dec 15.
Insidious Mycobacterium tuberculosis infection causing tubulointerstitial nephritis is a rare disorder. Here we report on a single-center case series of patients with tubulointerstitial nephritis due to tuberculosis, addressing clinicopathologic features and treatment outcome. Twenty-five adult patients with clinical evidence of tuberculosis and significant renal disease were assessed, 17 of whom had a kidney biopsy and were subsequently diagnosed with chronic granulomatous tubulointerstitial nephritis as the primary lesion. All patients were given standard antitubercular treatment, with some receiving corticosteroids, and showed a good response in clinical symptoms and inflammatory markers. Nine of the 25 patients, however, started renal replacement therapy within 6 months of presentation. Of the remaining 16, renal function improved for up to a year after presentation but subsequently declined through a median follow-up of 36 months. This case series supports that chronic tubulointerstitial nephritis is the most frequent kidney biopsy finding in patients with renal involvement from tuberculosis. Thus, a kidney biopsy should be considered in the clinical evaluation of kidney dysfunction with tuberculosis since tubulointerstitial nephritis presents late with advanced disease. A low threshold of suspicion in high-risk populations might lead to earlier diagnosis and treatment, preserving renal function and delaying initiation of renal replacement therapy.
导致肾小管间质性肾炎的潜伏性结核分枝杆菌感染是一种罕见的疾病。在这里，我们报告了一组由结核引起的肾小管间质性肾炎的单中心病例系列，探讨了其临床病理特征和治疗结果。评估了 25 例有临床结核病证据和严重肾脏疾病的成年患者，其中 17 例进行了肾脏活检，随后被诊断为原发性慢性肉芽肿性肾小管间质性肾炎。所有患者均接受标准抗结核治疗，部分患者接受皮质类固醇治疗，临床症状和炎症标志物均有良好反应。然而，25 例患者中有 9 例在出现症状后 6 个月内开始接受肾脏替代治疗。其余 16 例患者在出现症状后长达 1 年时间内肾功能有所改善，但在中位随访 36 个月后肾功能下降。本病例系列研究支持慢性肾小管间质性肾炎是结核病引起肾脏受累患者中最常见的肾脏活检表现。因此，对于伴有结核病的肾功能障碍患者，在临床评估时应考虑进行肾脏活检，因为肾小管间质性肾炎在晚期出现，且病情较重。在高危人群中保持高度警惕，可能会导致更早的诊断和治疗，从而保护肾功能，延迟开始肾脏替代治疗。
