Glomerulonephritis during Mycobacterium tuberculosis infection: scoping review

Area of Science:

• Nephrology
• Infectious Diseases
• Pathology

Background:

• Tuberculosis (TB) infection is associated with glomerulonephritis (GN), but presentations, pathologies, and outcomes are not fully understood.
• Distinguishing between TB-related and medication-induced GN, and the role of immunosuppression, require further clarification.

Purpose of the Study:

• To systematically review and summarize the clinical presentations, renal pathologies, and outcomes of patients with TB and GN.
• To identify predictors of GN etiology in TB-infected patients and inform diagnostic and management strategies.

Main Methods:

• A comprehensive scoping review of multiple databases (MEDLINE, EMBASE, Cochrane, Web of Science) was conducted.
• Data from 62 studies involving 130 patients with TB and GN who underwent renal biopsy were analyzed.

Main Results:

• A wide spectrum of GN presentations and 10 distinct renal pathologies were observed in TB patients.
• Specific findings like granulomas, anti-GBM disease, amyloidosis, and FSGS indicated TB-related GN, while minimal change disease suggested drug-induced GN.
• Immunosuppression was common in severe cases, but its efficacy was not confirmed; rifampin and isoniazid were linked to drug-associated GN.

Conclusions:

• Renal biopsy is crucial for diagnosing GN in TB patients, providing clear diagnostic criteria.
• This review outlines key predictors for GN etiology, aiding in the optimized diagnosis and management of TB-associated kidney disease.