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Tuberculosis in patients with end-stage renal disease
1Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Summary
Tuberculosis (TB) in patients with kidney failure often presents outside the lungs. Key indicators include fever, reversed albumin/globulin ratio, and high calcium levels, which are linked to mortality.
Area of Science:
- Nephrology
- Infectious Diseases
- Pulmonology
Background:
- Uremia, a condition of kidney dysfunction, complicates tuberculosis (TB) diagnosis and management.
- Extra-pulmonary TB is a significant concern in patients with end-stage renal disease.
Purpose of the Study:
- To identify clinical features and mortality risk factors in uremic patients with tuberculosis.
- To improve early diagnosis of TB in patients undergoing maintenance dialysis.
Main Methods:
- Retrospective analysis of 62 patients with uremia and active TB from 1990-2000.
- Follow-up for 2 years post-discharge or until death to assess mortality outcomes.
Main Results:
- Over half (51.6%) of patients had extra-pulmonary TB, primarily involving the peritoneum and pleura.
- Common manifestations included fever of unknown origin (77.4%), hypercalcemia (46.8%), elevated C-reactive protein, and leukocytosis.
- Reversed serum albumin/globulin ratio and leukocytosis were associated with increased mortality.
Conclusions:
- Extra-pulmonary TB is prevalent in patients with end-stage renal disease.
- Fever of unknown origin, reversed albumin/globulin ratio, and hypercalcemia in dialysis patients may indicate TB.
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