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Rapidly progressive glomerulonephritis in tuberculosis
Rajesh Waikhom1, Dipankar Sarkar, Mahesh Bennikal
1Department of Nephrology, Jawaharlal Nehru Institute of Medical Sciences, Porompat Imphal, India.
Summary
Tuberculosis can affect the kidneys, but glomerular involvement is rare. This case shows successful treatment of miliary tuberculosis with immune complex nephritis using anti-tuberculous therapy alone, avoiding immunosuppression.
Area of Science:
- Nephrology
- Infectious Diseases
- Immunology
Background:
- Renal tuberculosis is typically due to lympho-hematogenous spread.
- Glomerular involvement in renal tuberculosis is uncommon.
- Crescentic nephritis in tuberculosis presents a therapeutic challenge due to immunosuppression risks.
Observation:
- A patient presented with miliary tuberculosis and advanced renal injury requiring renal replacement therapy.
- Diagnosis was confirmed by positive sputum acid-fast bacilli (AFB), caseating granulomas in lymph nodes, and positive urinary mycobacterial PCR.
- The patient had immune complex crescentic nephritis.
Findings:
- Complete recovery of renal function was achieved with anti-tuberculous therapy.
- Immunosuppressive therapy was not required for managing the nephritis.
- This suggests a potential for non-immunosuppressive treatment in select cases.
Implications:
- This case highlights that renal tuberculosis with immune complex crescentic nephritis can be managed effectively with anti-tuberculous therapy alone.
- It offers a less risky therapeutic approach, avoiding immunosuppression in patients with active tuberculosis.
- Further research may explore the role of anti-tuberculous therapy as a primary treatment for tuberculous nephritis.
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