Tuberculosis in chronic renal failure stage V patients at a tertiary care nephology unit in India

Abstract

Purpose: There is a high incidence of TB in India. The immune dysfunction in patients with chronic renal failure Stage V (CRF-V) predisposed them to infections. Co-existing TB adds to morbidity and the treatment with anti-tubercular drugs requires knowledge of the proportion of drug excreted by kidneys and its clearance, the toxicity and the availability of alternate effective agents to cure the patient of TB. Analysis was aimed to know the incidence of TB in CKF-V patients. Methods & Materials: CRF-V patients between 1st April 2015 and 1st March 2018 were retrospectively analyzed for TB. Data were collected on the demographics, clinical presentation, laboratory methods of TB diagnosis, disease site, comorbidities and outcome of tuberculosis. Results: Out of a total 312 patients with CKD-V a total of 51 were screened for tuberculosis on basis of clinical suspicion by Microbiological / histopathological findings. Fever, weight loss and decrease appetite were the predominant clinical presentations. 7 patients were positive for Tuberculosis; the incidence being (13.7%) for tuberculosis. 57.2% were males & 42.8% were females. The co-morbid conditions were retroviral disease, diabetes and Systemic lupus erythematosus in one patient each. Extra pulmonary tuberculosis was diagnosed in 3 and pulmonary in 4. One patient was MDR and was managed on 2nd line drugs successfully. Only one patient died due to septic shock with CMV and PCP pneumoniae Conclusion: The incidence of tuberculosis was (13.7%) in CKD-V patients. Thus a high index of clinical suspicion & early diagnosis can promote a favorable patient outcome.