Acute Renal Failure Secondary to Tuberculosis: A Diagnostic Challenge

Khilji, Saeed I.; Kok, Hong Kuan; Wong, Limy; Dorman, Anthony; Walshe, J. Joseph

doi:10.1155/2012/510179

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…18 Nephrotic syndrome in LN is usually non-simple and combined with hematuria and even renal failure. 19 The current study found no significant differences in IgG, IgA, and IgM levels between patients with LN with and without renal damage, and between patients with mild and severe LN. However, the mean immunoglobulin levels were lower in patients with LN with renal damage and in patients with severe LN.…”

Section: Discussioncontrasting

confidence: 74%

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Clinical aspects and risk factors of lupus nephritis: a retrospective study of 156 adult patients

et al. 2019

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Objective To analyze the clinical manifestations, laboratory indexes, disease activity, and pathological types of lupus nephritis (LN) in adult patients. Methods We retrospectively analyzed the clinical manifestations, laboratory indexes, and pathological classifications of 156 adult patients first diagnosed with LN between July 2013 and November 2017. Patients were categorized according to the following criteria: active or inactive LN, LN with or without renal damage, and mild or severe LN. Results Immunoglobulin G and A levels, 24-hour proteinuria, and anti-dsDNA, anti-Sm, and anti-ribosomal P protein antibody positivity rates were all significantly increased in patients with active LN compared with inactive LN. Anti-dsDNA antibody positivity and 24-hour proteinuria were significantly increased, whereas hemoglobin, serum albumin, and C3 and C4 levels were significantly decreased in patients with LN and renal damage compared with those without renal damage. Anti-dsDNA and anti-Sm antibody positivity rates and 24-hour proteinuria were significantly increased, while hemoglobin, serum albumin, C3 and C4 levels, and estimated glomerular filtration rate were significantly decreased in patients with severe LN compared with patients with mild LN. Conclusions LN can display various clinical manifestations, laboratory indexes, levels of disease activity, and pathological types in adult patients.

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Section: Discussioncontrasting

confidence: 74%

“…18 Nephrotic syndrome in LN is usually non-simple and combined with hematuria and even renal failure. 19…”

Section: Discussionmentioning

confidence: 99%

Clinical aspects and risk factors of lupus nephritis: a retrospective study of 156 adult patients

et al. 2019

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“…Urine TB culture performed poorly, which has been noted previously . In one study of TB‐GIN, urine culture for Mycobacterium tuberculosis had a yield of 25% . All patients in our cohort with positive urine cultures for TB, and/or AFBs observed on the kidney biopsy, had microbiological evidence of TB elsewhere.…”

Section: Discussionmentioning

confidence: 99%

Granulomatous interstitial nephritis on renal biopsy in human immunodeficiency virus positive patients: Prevalence and causes in Cape Town, South Africa

et al. 2019

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South Africa continues to be burdened by human immunodeficiency virus (HIV) and tuberculosis (TB). In Cape Town, the epidemic of HIV‐TB co‐infection is as high as 70%. Granulomatous interstitial nephritis (GIN) has increased in frequency on renal biopsy. This study aimed to determine GIN prevalence and causes in HIV‐positive patients as well as renal outcomes, patient survival and associated factors. This observational cohort study reviewed HIV‐positive renal biopsies for GIN from 2005 to 2012. Causes of GIN (medications, TB, fungal and other), and baseline characteristics were analysed. A comparison of baseline data, renal function and survival was made between GIN and non‐GIN cohorts. There were 45/316 biopsies demonstrating GIN. TB was the likely cause of GIN in 27 (60%) and 9 (20%) were due to a drug. Low estimated glomerular filtration rate was a statistically significant factor associated with mortality in both GIN (P = 0.045) and non‐GIN cohorts (P < 0.000). In the GIN group, there were 12 (26.7%) deaths. Mortality for all patients was greatest in the first 6 months (P = 0.057). TB co‐infection in both cohorts was associated with a higher mortality. The multivariate logistic regression demonstrated that a higher urine protein/creatinine ratio (uPCR) and lower estimated glomerular filtration rate were statistically associated with death. GIN is common in HIV‐positive renal biopsies in Cape Town. TB‐GIN was the commonest cause and associated with a high early mortality. GIN should be considered in HIV‐positive patients with acute kidney injury, its presence conveys a survival benefit. There is a need for improved diagnostic accuracy and treatment strategies of TB‐GIN.

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The value of repeat biopsy in lupus nephritis flares

Narváez¹,

Ricse²,

Gomà³

et al. 2017

Medicine

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Whether a repeat renal biopsy is helpful during lupus nephritis (LN) flares remains debatable. In order to analyze the clinical utility of repeat renal biopsy in this complex situation, we retrospectively reviewed our series of 54 LN patients who had one or more repeat biopsies performed only on clinical indications. Additionally, we reviewed 686 well-documented similar cases previously reported (PubMed 1990–2015).The analysis of all patients reviewed showed that histological transformations are common during a LN flare, ranging from 40% to 76% of cases. However, the prevalence of transformations and the clinical value of repeat biopsy vary when they are analyzed according to proliferative or nonproliferative lesions.The great majority of patients with class II (78% in our series and 77.5% in the literature review) progressed to a higher grade of nephritis (classes III, IV, or V), resulting in worse renal prognosis. The frequency of pathological conversion in class V is lower (33% and 43%, respectively) but equally clinically relevant, since almost all cases switched to a proliferative class. Therefore, repeat biopsy is highly advisable in patients with nonproliferative LN at baseline biopsy, because these patients have a reasonable likelihood of switch to a proliferative LN that may require more aggressive immunosuppression.In contrast, the majority of patients (82% and 73%) with proliferative classes in the reference biopsy (III, IV or mixed III/IV + V), remained into proliferative classes on repeat biopsy. Although rebiopsy in this group does not seem as necessary, it is still advisable since it will allow us to identify the 18% to 20% of patients that switch to a nonproliferative class. In addition, consistent with the reported clinical experience, repeat biopsy might also be helpful to identify selected cases with clear progression of proliferative lesions despite the initial treatment, for whom it is advisable to intensify inmunosuppression. Thus, our experience and the literature data support that repeat biopsy also brings more advantges than threats in this group.The results of the repeat biopsy led to a change in the immunosuppresive treatment in more than half of the patients on average, intensifying it in the majority of the cases, but also reducing it in 5% to 30%.

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Acute Renal Failure Secondary to Tuberculosis: A Diagnostic Challenge

Cited by 4 publications

References 5 publications

Clinical aspects and risk factors of lupus nephritis: a retrospective study of 156 adult patients

Clinical aspects and risk factors of lupus nephritis: a retrospective study of 156 adult patients

Granulomatous interstitial nephritis on renal biopsy in human immunodeficiency virus positive patients: Prevalence and causes in Cape Town, South Africa

The value of repeat biopsy in lupus nephritis flares

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