title: Presentation, diagnosis, and treatment outcome of tuberculous-mediated tubulointerstitial nephritis.
abstract: Insidious Mycobacterium tuberculosis infection causing tubulointerstitial nephritis is a rare disorder. Here we report on a single-center case series of patients with tubulointerstitial nephritis due to tuberculosis, addressing clinicopathologic features and treatment outcome. Twenty-five adult patients with clinical evidence of tuberculosis and significant renal disease were assessed, 17 of whom had a kidney biopsy and were subsequently diagnosed with chronic granulomatous tubulointerstitial nephritis as the primary lesion. All patients were given standard antitubercular treatment, with some receiving corticosteroids, and showed a good response in clinical symptoms and inflammatory markers. Nine of the 25 patients, however, started renal replacement therapy within 6 months of presentation. Of the remaining 16, renal function improved for up to a year after presentation but subsequently declined through a median follow-up of 36 months. This case series supports that chronic tubulointerstitial nephritis is the most frequent kidney biopsy finding in patients with renal involvement from tuberculosis. Thus, a kidney biopsy should be considered in the clinical evaluation of kidney dysfunction with tuberculosis since tubulointerstitial nephritis presents late with advanced disease. A low threshold of suspicion in high-risk populations might lead to earlier diagnosis and treatment, preserving renal function and delaying initiation of renal replacement therapy.
authors.affiliation: Renal Unit, Barts and the London NHS Trust, London, UK. Electronic address: c_ananda@bartsandthelondon.nhs.uk.
authors.forename: Ananda
authors.initials: A
authors.lastname: Chapagain
authors.affiliation: Renal Unit, Barts and the London NHS Trust, London, UK.
authors.forename: Hamish
authors.initials: H
authors.lastname: Dobbie
authors.affiliation: Department of Histopathology, Barts and the London NHS Trust, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Sheaff
authors.affiliation: Renal Unit, Barts and the London NHS Trust, London, UK.
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Yaqoob
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001706:Biopsy; D002908:Chronic Disease; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000382:microbiology / Q000503:physiopathology; D008131:London; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000472:pathogenicity*; D009395:Nephritis, Interstitial / Q000175:diagnosis* / Q000208:ethnology / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy*; D011237:Predictive Value of Tests; D017582:Renal Replacement Therapy; D013997:Time Factors; D016896:Treatment Outcome; D014398:Tuberculosis, Renal / Q000175:diagnosis* / Q000188:drug therapy* / Q000208:ethnology / Q000382:microbiology / Q000503:physiopathology; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000995:Antitubercular Agents