Tuberculosis and pauci-immune crescentic glomerulonephritis

Area of Science:

• Nephrology
• Infectious Diseases
• Pulmonology

Background:

• Pauci-immune crescentic glomerulonephritis (c-GN) is a severe kidney disease often associated with autoimmune conditions.
• Tuberculosis (TB) is a significant global health issue, primarily affecting the lungs but capable of causing systemic manifestations.

Observation:

• A 47-year-old man presented with symptoms suggestive of pulmonary tuberculosis, including cough, hemoptysis, and weight loss.
• Urinalysis revealed active urinary sediment with red blood cell casts, and chest radiography showed cavitation.
• He was diagnosed with pauci-immune c-GN on renal biopsy, with negative ANCA serology.

Findings:

• Sputum PCR confirmed drug-sensitive Mycobacterium tuberculosis infection.
• Treatment with standard anti-TB medications, prednisone, and cyclophosphamide was initiated.
• Renal function improved substantially over six months, with eGFR exceeding 60 mL/min.

Implications:

• This case underscores TB as a treatable, non-autoimmune cause of c-GN.
• Early diagnosis and combined treatment of TB and c-GN are crucial for renal recovery.
• Highlights the importance of considering infectious etiologies in glomerulonephritis, particularly in endemic areas.