结核病和慢性肾脏病:一种新出现的全球综合征。
Tuberculosis and chronic kidney disease: an emerging global syndemic.
机构信息
Faculty of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, British Columbia, Canada.
University of Ottawa, Ottawa Hospital Research Institute, Kidney Research Centre, and Division of Nephrology, The Ottawa Hospital, Ottawa, Ontario, Canada.
出版信息
Kidney Int. 2016 Jul;90(1):34-40. doi: 10.1016/j.kint.2016.01.034. Epub 2016 May 10.
The link between chronic kidney disease (CKD) and tuberculosis (TB) has been known for more than 40 years, but the interaction between these 2 diseases is still poorly understood. Dialysis and renal transplant patients appear to be at a higher risk of TB, in part related to immunosuppression along with socioeconomic, demographic, and comorbid factors. Meanwhile, TB screening and diagnostic test performance is suboptimal in the CKD population, and there is limited evidence to guide protocols. Given the increasing prevalence of CKD in TB endemic areas, a merging of CKD and TB epidemics could have significant public health implications, especially in low- to middle-income countries such as India and China, that are experiencing rapid increases in CKD prevalence and account for more than one-third of global TB prevalence. To begin addressing TB-CKD, a clear understanding of the relationship between these 2 conditions needs to be established, and consistent, evidence-based screening and treatment guidelines need to be developed.
慢性肾脏病 (CKD) 和结核病 (TB) 之间的联系已经存在了 40 多年,但这两种疾病之间的相互作用仍知之甚少。透析和肾移植患者似乎面临更高的结核病风险,部分原因与免疫抑制以及社会经济、人口和合并症等因素有关。同时,在 CKD 患者中,结核病筛查和诊断检测的性能并不理想,也缺乏指导方案的证据。鉴于在结核病流行地区 CKD 的患病率不断上升,如果 CKD 和结核病流行合并,将对公共卫生产生重大影响,尤其是在印度和中国等经历 CKD 患病率快速上升的中低收入国家,这两个国家的 CKD 患病率占全球的三分之一以上。为了开始解决 TB-CKD 问题,需要明确了解这两种情况之间的关系,并制定一致的、基于证据的筛查和治疗指南。