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The most common presentations of nontuberculous mycobacterial infections in kidney transplant recipients (KTR) are cutaneous and disseminated diseases. Pleuropulmonary infection not associated with disseminated disease is rare. Its diagnosis can be difficult, requiring a combination of clinical, radiological, and bacteriological criteria. We report on a Mycobacterium avium complex pulmonary infection in a KTR with underlying chronic obstructive pulmonary disease. Chest computed tomography showed an excavated lesion of the right upper lobe, similar to a typical lesion of pulmonary tuberculosis. Evolution was favorable with multiple-drug therapy including rifampicin, ethambutol, and clarithromycin, along with a slight reduction in immunosuppression. We review the literature and discuss the epidemiology, diagnosis, management, and follow-up of this uncommon post-transplant complication.

change the National Kidney Foundation guidelines recommending early start (estimated glomerular filtration rate over 10 ml/min per m 2 ) fail to consider the fact that dialyzer clearances have not been shown to relate to patient survival in two randomized controlled trials. 2 Indeed it is illogical to think that small-molecule dialyzer clearance provides a more significant benefit than a patient's own residual renal function, which provides middle molecular as well as other kidneyspecific benefits. Early dialysis leads to loss of this important predictor of survival and is another reason why we caution the nephrology community to examine the wisdom of the trend to start dialysis early.1. Bargman J. The CANUSA study and the importance of residual kidney function in dialysis patients.