[The TB infection in children with chronic renal diseases]

The incidence of tuberculosis in the general population has risen in Romania over the past years. It is, therefore, presumable that this incidence is higher in the immuno-compromised hosts than in the general population.

We analysed the tuberculosis incidence in children with a chronic renal disease, the favourable factors, and also the tuberculosis impact on the evolution of the renal disease. The tracing period was of 12 years, the lot being composed of 168 patients: 96 with primitive or secondary chronic renal diseases who were treated with immunosuppressive agents and 72 with ESRD, undergoing chronic dialysis. The study traced: the main disease, the immunosuppressive therapy received at the time of the TB diagnosis, the age of the main disease at the time of the TB diagnosis and its evolution stage, the proper framing within the disease type.

There were 22 cases of tuberculosis diagnosed (22.03%), 2 ending in deaths. 10 were TB-infected (positive tuberculin skin test-TST) and 12 had TB-disease (5 cases of pulmonary and 6 of extra-pulmonary TB). The period between the diagnosing of the renal disease and that of the TB was, in average, around 6 months (between 0-48 months). Contact with other ill persons existed in only one case. Out of the cases diagnosed with TB, immunosuppression was present as a favouring factor in 9 cases (75%)--2 cases with ESRD and 7 cases with immunosuppressive therapy for the active renal disease. 4 cases with cortico-resistant nephritic syndrome (3 cases with mesangioproliferative glomerulonephritis and one case which did not undergo biopsy) responded to the immunosuppressive treatment after the tuberculostatic treatment.

The tracing of the TB infection is compulsory in the groups of patients presenting risks, even in the absence of suggestive epidemiologic data. Tuberculosis induces resistance to the immunosuppressive therapy, the remission being dependent on the efficiency of the tuberculostatic treatment.