title: [Chronic renal failure: unexpected late sequela of pulmonary tuberculosis after 30 years].
abstract: Tuberculosis-related chronic granulomatous tubulointerstitial nephritis (GTN) and chronic renal dysfunction as a consequence of GTN is a rarely seen clinical condition, with a few case reports in the literature. In this report, a case with end stage renal failure as an unexpected late extrapulmonary sequela of tuberculosis has been presented. A 60 years old female patient was admitted to hospital with the complaints of fever, malaise and nausea. Her history revealed that she had pulmonary tuberculosis 30 years ago and received antituberculosis therapy for nine months. The laboratory results on admission were as follows: blood urea nitrogen 90 mg/dl, serum creatinine 9 mg/dl, sodium 116 mEq/L, potassium 6.6 mEq/L, albumine 2.9 g/dl, hemoglobin, 8.4 g/dl, white blood cell count 10.800/mm3, C-reactive protein 187 mg/L and erythrocyte sedimentation rate 110 mm/hour. Urinalysis showed 8.1 g/L protein, 10-12 leukocytes, 1-2 erythrocytes, while 24-hours urinalysis yielded proteinuria with 8 ml/minutes creatinine clearance value. Urine and blood cultures of the patient revealed neither bacteria or mycobacteria. PPD skin test was negative. Acid-resistant bacilli (ARB) were not detected in sequential urine samples obtained on three consecutive days. Since sputum samples could not be obtained, diagnostic procedures for sputum were not performed. Abdomen ultrasonography yielded bilateral edema and grade II echogenity in kidneys. Computed tomography of the chest showed bilateral pulmonary nodules, chronic sequela lesions, pleural scarring and calcifications, as well as minimal interstitial infiltrate. Transthoracic lung biopsy showed chronic inflammation and fibrosis, while amyloid was negative. Renal biopsy showed GTN with central caseified necrosis and granulomas, multinuclear giant cells, tubular atrophy and interstitial fibrosis. Amyloid was negative and ARB were not detected in renal biopsy sample. Definitive diagnosis was achieved by the demonstration of Mycobacterium tuberculosis nucleic acid in kidney biopsy by polymerase chain reaction (PCR). Antituberculosis therapy was not initiated since there were no signs of active tuberculosis. The patient became clinically stable following dialysis and was discharged, however, she has been undergoing hemodialysis three times a week. The aim of this case presentation was to emphasize that renal tuberculosis should be considered in the differential diagnosis of patients with end stage renal failure, especially in countries like Turkey where tuberculosis incidence is high.
authors.affiliation: Başkent University Faculty of Medicine, Adana Application and Research Center, Department of Nephrology, Adana, Turkey. azumrutdal@yahoo.com
authors.forename: Ayşegül
authors.initials: A
authors.lastname: Zümrütdal
authors.forename: Ismail
authors.initials: I
authors.lastname: Yıldız
authors.forename: Rüya
authors.initials: R
authors.lastname: Ozelsancak
authors.forename: Tuba
authors.initials: T
authors.lastname: Canpolat
mesh_terms: D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008168:Lung / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D008875:Middle Aged; D009395:Nephritis, Interstitial / Q000150:complications / Q000175:diagnosis / Q000382:microbiology*; D011859:Radiography; D006435:Renal Dialysis; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000188:drug therapy; D014398:Tuberculosis, Renal / Q000150:complications / Q000175:diagnosis / Q000209:etiology*; D014463:Ultrasonography