Vikrant Sanjay
Department of Nephrology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
Saudi J Kidney Dis Transpl. 2019 Mar-Apr;30(2):470-477. doi: 10.4103/1319-2442.256854.
The objective is to study the clinical profile of tuberculosis (TB) in chronic kidney disease (CKD). This is retrospective study of CKD patients who were diagnosed to have TB over a period of seven years at a tertiary care hospital. TB was diagnosed in 115 patients with an incidence of 4200/100,000. Mean age of the patients was 46.9 ± 16 years. Sixty-two patients (53.9%) were male. Causes of CKD were diabetic nephropathy and hypertension in 11.3% each, chronic glomerulonephritis in 31.3%, chronic tubulointerstitial nephritis in 39.1%, autosomal dominant polycystic kidney disease, and post-renal transplant CKD in 3.5% each. About 68.7% of patients with TB had advanced CKD stage of 4-5D, whereas 31.3% of patients had early CKD stage 1-3. Twenty percent of patients were on dialysis. Three-fourths of the patients had extrapulmonary TB. Pleuropulmonary (41.8%), kidney and urinary tract (20%), and abdomen and lymph node (13% each) were the most common sites for TB. The main clinical presentation of TB was: fever/pyrexia of unknown origin in 24.3%, constitutional symptoms of anorexia, fever, night sweats, and weight loss in 27.8%, abnormal chest radiograph in 31.2%, ascites/peritonitis in 13.9%, pleural effusion in 25.2%, lymphadenopathy in 20%, and sterile pyuria/hematuria/chronic pyelonephritis in 13%. Microbiological and/or histopathological diagnoses were made in 45.2% and in the other 54.8%, diagnosis of TB was made on clinical grounds. Adverse effects of anti-TB drugs were seen in 9.6% of patients. Ninety-three percent completed the treatment and survived. Eight patients (7%), all in CKD stage 5D, died. The incidence of TB was high among CKD stages 4 and 5 and in those receiving dialysis. Extrapulmonary disease such as pleuropulmonary, renal, peritoneal, and lymph node were the common forms of TB.
目的是研究慢性肾脏病（CKD）患者中结核病（TB）的临床特征。这是一项对一家三级护理医院七年间被诊断患有结核病的CKD患者的回顾性研究。115例患者被诊断为结核病，发病率为4200/100,000。患者的平均年龄为46.9±16岁。62例患者（53.9%）为男性。CKD的病因分别为糖尿病肾病和高血压，各占11.3%，慢性肾小球肾炎占31.3%，慢性肾小管间质性肾炎占39.1%，常染色体显性多囊肾病和肾移植后CKD各占3.5%。约68.7%的结核病患者处于CKD 4-5D晚期，而31.3%的患者处于CKD 1-3早期。20%的患者接受透析。四分之三的患者患有肺外结核。胸膜肺（41.8%）、肾脏和泌尿系统（20%）以及腹部和淋巴结（各占13%）是结核病最常见的部位。结核病的主要临床表现为：不明原因发热/高热占24.3%，厌食、发热、盗汗和体重减轻等全身症状占27.8%，胸部X线异常占31.2%，腹水/腹膜炎占13.9%，胸腔积液占25.2%，淋巴结病占20%，无菌性脓尿/血尿/慢性肾盂肾炎占13%。45.2%的患者进行了微生物学和/或组织病理学诊断，另外54.8%的患者根据临床情况诊断为结核病。9.6%的患者出现了抗结核药物的不良反应。93%的患者完成治疗并存活。8例患者（7%）均处于CKD 5D期，死亡。CKD 4期和5期以及接受透析的患者中结核病发病率较高。胸膜肺、肾脏、腹膜和淋巴结等肺外疾病是结核病的常见形式。
