Tuberculosis in renal failure: a high incidence in patients born in the Third World

We report 11 cases of tuberculosis among patients with chronic renal failure being treated in our unit. All were born outside the United Kingdom, and represent 25% of the non-europid patients in the unit. This is about a seventy-fold increased incidence of tuberculosis in this group. Diagnosis is difficult and mortality high if the diagnosis is delayed. Culture of tissue biopsies is the most reliable investigation and chemotherapy should be commenced promptly or a therapeutic trial considered in doubtful cases. Chemoprophylaxis may be beneficial in patients from these ethnic groups or in any uremic patient with evidence of old tuberculosis. Three patients with advanced disease died despite antibiotic treatment, but in the remainder, triple therapy with normal doses of rifampicin, isoniazid and pyrazinamide proved safe and effective.