Waikhom Rajesh, Sarkar Dipankar, Bennikal Mahesh, Pandey Rajendra
Department of Nephrology, Jawaharlal Nehru Institute of Medical Sciences, Porompat Imphal, India.
Saudi J Kidney Dis Transpl. 2014 Jul;25(4):872-5. doi: 10.4103/1319-2442.135187.
Renal involvement in tuberculosis occurs due to lympho-hematogenous dissemination. However, glomerular involvement is an uncommon event. Crescentic nephritis complicating tuberculosis is a therapeutic dilemma and weighs the risk of worsening the infection after immunosuppressive therapy. We present here a case of miliary tuberculosis with immune complex crescentic nephritis with advanced renal injury requiring renal replacement therapy. A diagnosis of miliary tuberculosis was made on the basis of positive sputum AFB, lymph node biopsy showing caseating granulomas and urinary polymerase chain reaction being positive for mycobacterial antigens. The patient recovered renal function with anti-tuberculous therapy with-out requiring immunosuppressive therapy.
肾脏结核是由淋巴-血行播散引起的。然而，肾小球受累并不常见。结核合并新月体性肾炎是一个治疗难题，需要权衡免疫抑制治疗后感染加重的风险。我们在此报告一例粟粒性结核合并免疫复合物新月体性肾炎的病例，该患者存在晚期肾损伤，需要肾脏替代治疗。根据痰涂片抗酸杆菌阳性、淋巴结活检显示干酪样肉芽肿以及尿聚合酶链反应检测到结核分枝杆菌抗原阳性，诊断为粟粒性结核。患者接受抗结核治疗后肾功能恢复，无需免疫抑制治疗。
