A Clinical Profile of Tuberculosis in CKD Patients and the Response to Modified Att

Abstract

BACKGROUND Tuberculosis (TB) is one of the major causes of mortality across the world. Patients with CKD are at high risk of developing TB due to the immunosuppressive effects of uraemia. There is limited information on the magnitude of problem of TB in patients with CKD. Aim: The aim of the study was to find out the clinical profile and response to treatment of TB in CKD patients. MATERIALS AND METHODSThis is a descriptive study carried out on 55 cases of CKD. The patients were grouped into various stages of CKD based on GFR calculated using the MDRD equation. The microbiological, histopathological, radiological and newer diagnostic investigations were noted for each patient with TB. Also, the duration of ATT taken, and any incidence of adverse drug reaction were observed. RESULTSIn our study subjects, the mean age was 40 yrs., of which 75% constituted males and 25% females. Majority the patients were of post-renal transplant and stage V (31% each). Pulmonary TB contributed 64% cases (Majority in Stage IV and V) and extrapulmonary TB 36% (especially in post-renal transplant subjects). The mean duration of ATT was 7 months with 28 cases of treatment completed, 23 cured, 1 failed and 3 defaulters. Only 1.8% patients developed adverse drug event in the form of peripheral neuropathy, due to INH, despite taking pyridoxine supplements. CONCLUSIONIncidence of Pulmonary TB is more common in post-transplant subjects, whereas extrapulmonary TB (Lymph node) is more common in CKD subjects. A high index of suspicion should be maintained by ensuring early screening for risk factors like smoking, alcoholism and diabetes mellitus as they predispose CKD patients to tuberculosis. GeneXpert assay is a novel and reliable diagnostic modality for TB, especially in CKD subjects for whom many of the conventional methods may be negative.