ИЗУЧЕНИЕ ЦИТОКИНОВОГО ПРОФИЛЯ У БОЛЬНЫХ ХРОНИЧЕСКОЙ БОЛЕЗНЬЮ ПОЧЕК 5-Й СТАДИИ И ТУБЕРКУЛЕЗОМ

Abstract

In the recent years detection and diagnosis of TB has widely involved such immunological tests as the recombinant tuberculosis allergen (RTA) skin test (Diaskintest®) and interferon gamma release assay (IGRA) tests. However, numerous defects of cellular and humoral immunity in patients with stage 5 chronic kidney disease (CKD) lower sensitivity of the above tests for TB detection (42% and 47% respectively). The altered immune response in stage 5 CKD patients dictates the need for search for other biomarkers of TB infection for this specific category of patients. The review analyzes literature data for the recent 30 years related to scientific research into cytokine profiling in stage 5 CKD patients with TB infection as a specific comorbid group. We have compared data on immunological studies of TB patients without uremia, including quantitative evaluation of innate immunity cytokines (some interleukins, tumor necrosis factor α) and enzyme immunoassay, analysis of cytokine gene expression using real-time polymerase chain reaction. The data on immune defects in CKD patients on renal replacement therapy (hemodialysis) are represented. The data on elevated concentrations of inflammation markers in dialysis patients and the information about the correlation between dialysis duration and cytokine concentrations are provided. False negative results of immunological tests for TB in CKD patients are partially explained. The current tendencies in search for TB infection biomarkers in CKD patients, including those on renal replacement therapy, are shown, as well asthe tendencies in search for TB activity markers and responses to TB treatment. Despite the controversial data, we believe that our study of immune responses of stage 5 CKD patients can provide the basis for the development of new tools for detection and diagnosis of TB infection in this immunocompromised group. The study of cytokine production in stage 5 CKD patients provides opportunities for the development of new diagnostic tests and/or markers of TB infection activity in this specific group of patients.