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Kalyesubula R, Wearne N, Kubo M, Hussey N, Naicker S. HIV and Associated TB: A Lethal Association for Kidney Health? Semin Nephrol 2023; 43:151470. [PMID: 38245391 DOI: 10.1016/j.semnephrol.2023.151470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Human immunodeficiency virus (HIV) and tuberculosis (TB) are the leading infectious causes of death globally. The combined brunt of these diseases is experienced mainly in low-income and lower-middle-income countries. HIV/TB have devastating effects on the kidneys, leading to accelerated decline of kidney function as well as mortality. Managing the triad of TB/HIV and kidney disease is challenging. We discuss the epidemiology of HIV/TB coinfection and the kidney and the key mechanisms of kidney disease including genetic susceptibility. The clinical presentation and pathology, as well as the challenges of diagnosing CKD in these patients, also are discussed. The strategies to prevent and manage HIV/TB-related kidney disease such as proper assessment, avoiding nephrotoxic regimens, drug dose adjustments, kidney function monitoring, avoidance of drug-drug interactions, and other interventions are explored. We also briefly discuss the complexities around HIV/TB patients on dialysis and kidney transplantation. HIV/TB coinfection presents an increased risk for kidney-related morbidity and mortality; patients with this triad need to be given special consideration for future research and management.
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Affiliation(s)
- Robert Kalyesubula
- Department of Physiology and Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Nicola Wearne
- Division of Nephrology and Hypertension, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Mary Kubo
- Department of Clinical Medicine and Therapeutics, East African Kidney Institute, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya.
| | - Nadia Hussey
- Division of Nephrology and Hypertension, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Saraladevi Naicker
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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2
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Pagaduan JV, Altawallbeh G. Advances in TB testing. Adv Clin Chem 2023; 115:33-62. [PMID: 37673521 PMCID: PMC10056534 DOI: 10.1016/bs.acc.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Globally, tuberculosis (TB) was the leading cause of death from a single infectious agent until the coronavirus (COVID-19) pandemic. In 2020, an estimated 10 million people fell ill with TB and a total of 1.5 million people died from the disease. About one-quarter of the global population, almost two billion people, is estimated to be latently infected with Mycobacterium tuberculosis (MTB). Although latent TB infection (LTBI) is asymptomatic and noncontagious, about 5-10% of LTBI patients have a lifetime risk of progression to active TB. The diagnosis and treatment of active cases are extremely vital for TB control programs. However, achieving the End TB goal of 2035 without the ability to identify and treat the pool of latently infected individuals will be a big challenge. To do so, improved technology to provide more accurate diagnostic tools and accessibility are crucial. Therefore, this chapter covers the current WHO-endorsed tests and advances in diagnostic and screening tests for active and latent TB.
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Affiliation(s)
- Jayson V Pagaduan
- Intermountain Central Laboratory Intermountain Medical Center, Murray, UT, United States
| | - Ghaith Altawallbeh
- Intermountain Central Laboratory Intermountain Medical Center, Murray, UT, United States.
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3
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Suehiro Y, Ueda H, Motohashi S, Honma S, Nobayashi H, Ueda R, Maruyama Y, Horino T, Ogasawara Y, Joh K, Tsuboi N, Yokoo T. Interferon-gamma Release Assay-positive Granulomatous Interstitial Nephritis in a Patient with a History of Diffuse Large B Cell Lymphoma. Intern Med 2022. [PMID: 36351581 DOI: 10.2169/internalmedicine.0648-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Tuberculosis is a common etiology of granulomatous interstitial nephritis (GIN). However, the absence of evidence of lung involvement and lack of mycobacterial isolation in cultures make the etiological diagnosis and treatment decision challenging. We herein report a 46-year-old man with severe renal failure, a persistent fever, and a history of lymphoma. A renal biopsy exhibited GIN. Despite no evidence of tuberculosis except for a positive interferon-gamma release assay (IGRA), the patient was successfully treated with anti-tuberculosis drugs. Our case suggests that anti-tuberculosis therapy should be considered for patients with IGRA-positive GIN after excluding other etiologies.
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Affiliation(s)
- Yohei Suehiro
- Division of Nephrology and Hypertension, the Jikei University School of Medicine, Japan
| | - Hiroyuki Ueda
- Division of Nephrology and Hypertension, the Jikei University School of Medicine, Japan
| | - Saya Motohashi
- Division of Nephrology and Hypertension, the Jikei University School of Medicine, Japan
| | - Shiko Honma
- Department of Pathology, the Jikei University School of Medicine, Japan
| | - Hiroki Nobayashi
- Division of Nephrology and Hypertension, the Jikei University School of Medicine, Japan
| | - Risa Ueda
- Division of Nephrology and Hypertension, the Jikei University School of Medicine, Japan
| | - Yukio Maruyama
- Division of Nephrology and Hypertension, the Jikei University School of Medicine, Japan
| | - Tetsuya Horino
- Department of Infectious Diseases and Infection Control, the Jikei University School of Medicine, Japan
| | - Yoji Ogasawara
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, the Jikei University School of Medicine, Japan
| | - Kensuke Joh
- Department of Pathology, the Jikei University School of Medicine, Japan
| | - Nobuo Tsuboi
- Division of Nephrology and Hypertension, the Jikei University School of Medicine, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, the Jikei University School of Medicine, Japan
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4
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Disseminated Mycobacterium Tuberculosis and IgA Nephropathy. Case Rep Nephrol 2022; 2022:3785713. [DOI: 10.1155/2022/3785713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/25/2022] [Indexed: 11/07/2022] Open
Abstract
Mycobacterium tuberculosis (MTB) is an under-recognised cause of genitourinary disease. IgA nephropathy (IgAN), a leading cause of glomerulonephritis worldwide, has been described as a rare consequence of disseminated MTB infection. In this case report, we present the first case of MTB associated IgAN in Africa. Finding IgAN on kidney biopsy in an MTB endemic area should prompt a thorough investigation for MTB to increase the chance of remission of IgAN and prevent inappropriate use of immunosuppression.
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Singh R, Shaheer M, Sobhia ME. Molecular dynamic assisted investigation on impact of mutations in deazaflavin dependent nitroreductase against pretomanid: a computational study. J Biomol Struct Dyn 2022:1-23. [PMID: 35574601 DOI: 10.1080/07391102.2022.2069156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In the past decade, TB drugs belonging to the nitroimidazole class, pretomanid and delamanid, have been authorised to treat MDR-TB and XDR-TB. With a novel inhibition mechanism and a reduction in the span of treatment, it is now being administered in various combinations. This approach is not the ultimate remedy since the target protein Deazaflavin dependent nitroreductase (Ddn) has a high mutation frequency, and already pretomanid resistant clinical isolates are reported in various studies. Ddn is essential for M.tuberculosis to emerge from hypoxia, and point mutations in critical residues confer resistance to Nitro-imidazoles. Among the pool of available mutants, we have selected seven mutants viz DdnL49P, DdnY65S, DdnS78Y, DdnK79Q, DdnW88R, DdnY133C, and DdnY136S, all of which exhibited resistance to pretomanid. To address this issue, through computational study primarily by MD simulation, we attempted to elucidate these point mutations' impact and investigate the resistance mechanism. Hence, the DdnWT and mutant (MT) complexes were subjected to all-atom molecular dynamics (MD) simulations for 100 ns. Interestingly, we observed the escalation of the distance between cofactor and ligand in some mutants, along with a significant change in ligand conformation relative to the DdnWT. Moreover, we confirmed that mutations rendered ligand instability and were ejected from the binding pocket as a result. In conclusion, the results obtained provide a new structural insight and vital clues for designing novel inhibitors to combat nitroimidazole resistanceCommunicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Ravi Singh
- Department of Pharmacoinformatics, National Institute of Pharmaceutical Education and Research (NIPER), Punjab, India
| | - Muhammed Shaheer
- Department of Pharmacoinformatics, National Institute of Pharmaceutical Education and Research (NIPER), Punjab, India
| | - M Elizabeth Sobhia
- Department of Pharmacoinformatics, National Institute of Pharmaceutical Education and Research (NIPER), Punjab, India
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6
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Chou YC, Lee WY, Huang SK, Wu RH, Kuo YT. Ten-year follow-up of renal adenomatosis with magnetic resonance imaging: a case report. J Med Case Rep 2022; 16:168. [PMID: 35449090 PMCID: PMC9026678 DOI: 10.1186/s13256-022-03394-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/30/2022] [Indexed: 11/21/2022] Open
Abstract
Background Renal adenomatosis is a rare disease that presents as multiple papillary adenomas in the bilateral kidneys. Moreover, papillary adenoma is considered a precursor to papillary renal cell carcinoma. Therefore, patients with renal adenomatosis may have higher risk of developing malignancy than patients without this benign condition. Case presentation We present the case of a 62-year-old Asian woman with past history of papillary thyroid cancer. She underwent contrast-enhanced magnetic resonance imaging of the abdomen to screen for metastasis in 2010 and was followed up with computed tomography or magnetic resonance imaging annually. She was found to have a right renal tumor on computed tomography and underwent partial nephrectomy. The pathological diagnosis of the right renal tumor was angiomyolipoma. Renal adenomatosis was also histologically confirmed in the renal parenchyma adjacent to the angiomyolipoma. In this case report, we demonstrate the natural course of renal adenomatosis over 10 years using imaging studies. The benign tumors gradually progressed during the follow-up period. Larger tumor sizes and more hypoenhanced nodules in the bilateral kidneys were observed on follow-up computed tomography and magnetic resonance imaging. Conclusions Due to its malignant potential, the clinical course of renal adenomatosis must be monitored. We present the natural course of renal adenomatosis with magnetic resonance imaging during a 10-year follow-up period.
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Affiliation(s)
- Yi-Chen Chou
- Department of Medical Imaging, Chi Mei Medical Center, 901, Chung-Hwa Road, Yung-Kang, Tainan, 710, Taiwan
| | - Wen-Ying Lee
- Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Pathology, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Steven K Huang
- Department of Urology, Chi Mei Medical Center, Tainan, Taiwan
| | - Reng-Hong Wu
- Department of Medical Imaging, Chi Mei Medical Center, 901, Chung-Hwa Road, Yung-Kang, Tainan, 710, Taiwan
| | - Yu-Ting Kuo
- Department of Medical Imaging, Chi Mei Medical Center, 901, Chung-Hwa Road, Yung-Kang, Tainan, 710, Taiwan. .,Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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7
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Ismatov B, Sereda Y, Sahakyan S, Gadoev J, Parpieva N. Hospitalizations and Treatment Outcomes in Patients with Urogenital Tuberculosis in Tashkent, Uzbekistan, 2016-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094817. [PMID: 33946457 PMCID: PMC8124920 DOI: 10.3390/ijerph18094817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022]
Abstract
Despite the global shift to ambulatory tuberculosis (TB) care, hospitalizations remain common in Uzbekistan. This study examined the duration and determinants of hospitalizations among adult patients (≥18 years) with urogenital TB (UGTB) treated with first-line anti-TB drugs during 2016–2018 in Tashkent, Uzbekistan. This was a cohort study based on the analysis of health records. Of 142 included patients, 77 (54%) were males, the mean (±standard deviation) age was 40 ± 16 years, and 68 (48%) were laboratory-confirmed. A total of 136 (96%) patients were hospitalized during the intensive phase, and 12 (8%) had hospital admissions during the continuation phase of treatment. The median length of stay (LOS) during treatment was 56 days (Interquartile range: 56–58 days). LOS was associated with history of migration (adjusted incidence rate ratio (aIRR): 0.46, 95% confidence interval (CI): 0.32–0.69, p < 0.001); UGTB-related surgery (aIRR: 1.18, 95% CI: 1.01–1.38, p = 0.045); and hepatitis B comorbidity (aIRR: 3.18, 95% CI: 1.98–5.39, p < 0.001). The treatment success was 94% and it was not associated with the LOS. Hospitalization was almost universal among patients with UGTB in Uzbekistan. Future research should focus on finding out what proportion of hospitalizations were not clinically justified and could have been avoided.
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Affiliation(s)
- Bakhtiyor Ismatov
- Republican Specialized Scientific and Practical Medical Center of Tuberculosis and Pulmonology, Tashkent 100086, Uzbekistan;
- Correspondence: ; Tel.: +998-909-669-960
| | | | - Serine Sahakyan
- Armenia and Tuberculosis Research and Prevention Center NGO, Yerevan 0034, Armenia;
| | - Jamshid Gadoev
- World Health Organization (WHO) Country Office in Uzbekistan, Tashkent 100100, Uzbekistan;
| | - Nargiza Parpieva
- Republican Specialized Scientific and Practical Medical Center of Tuberculosis and Pulmonology, Tashkent 100086, Uzbekistan;
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8
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Prihadi JC, Putra AC, Wahyudi Y. Biopsy-confirmed Genitourinary Tuberculosis in a Secondary Health Care Hospital: An Evidence-based Clinical Review. Res Rep Urol 2021; 13:133-137. [PMID: 33763390 PMCID: PMC7982704 DOI: 10.2147/rru.s286899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/08/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Tuberculosis (TB) is a worldwide disease and remains a major public health problem in developing countries, with 95% of cases occurring in developing countries, including Indonesia. It is caused by Mycobacterium tuberculosis, an acid-fast aerobic bacillus. When M. tuberculosis infects other than lung, it is called extrapulmonary tuberculosis (EPTB). Among other organs, genitourinary tuberculosis (GUTB) is responsible for 30–40% of all EPTB cases. Methods The study was conducted in a secondary health-care hospital in central Jakarta over a five-year period. We took data from hospital’s medical records and collected all the positive histopathological reports on biopsied tissue of the genitourinary tract from 2014–2019. Results Eleven patients showed positive histopathological results for TB on their biopsied genitourinary tissue. The genitourinary tracts involved were as follows: prostate (n=2), kidney (n=1), ureter (n=2), epididymis (n=1), epididymo-orchitis (n=1), bladder (n=4). All of them presented with specific genitourinary symptoms, such as lower urinary tract symptoms (LUTS) (n=8), dysuria (n=9), urinary retention (n=2), flank pain (n=6), and incontinence (n=1). Nine of 11 patients (81.8%) exhibited systemic manifestations, with fever being the most common (n=8), followed by malaise (n=6), dyspepsia syndrome (n= 4), and weight loss (n=3). Discussion Consistent with other studies, our research found that the prevalence of GUTB is substantially decreased with advancing age. Kidney is the most common site infected in GUTB infection. GUTB is easily overlooked, because its signs and symptoms are usually typical of a conventional bacterial cystitis. Conclusion Because of its insidious nature and late-onset symptoms, diagnosis of GUTB is often late to approach, leading to higher morbidity and even mortality rate. This leads into further complications of the disease, which are largely preventable by a correct and timely diagnosis followed by appropriate therapy.
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Affiliation(s)
- Johannes Cansius Prihadi
- Department of Surgery, Urology Division, School of Medicine and Health Sciences, Atma Jaya Catholic University, Jakarta, Indonesia.,Department of Urology, St. Carolus Hospital, Jakarta, Indonesia
| | - Andika Chandra Putra
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Department of Pulmonology and Respiratory Medicine, St. Carolus Hospital, Jakarta, Indonesia
| | - Yuvi Wahyudi
- Department of Urology, St. Carolus Hospital, Jakarta, Indonesia
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9
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Radwan A, Menias CO, El-Diasty MT, Etchison AR, Elshikh M, Consul N, Nassar S, Elsayes KM. Multimodality Imaging of Genitourinary Tuberculosis. Curr Probl Diagn Radiol 2020; 50:867-883. [PMID: 33272721 DOI: 10.1067/j.cpradiol.2020.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/10/2020] [Accepted: 10/16/2020] [Indexed: 01/27/2023]
Abstract
Tuberculosis (TB) prevalence has increased over the past few decades, especially in the developing world. The genitourinary tract is the most common extra-pulmonary location of TB. Symptoms of genitourinary TB are often vague. Diagnosis of genitourinary TB requires a high level of clinical suspicion. Healthcare providers must be familiar with genitourinary TB imaging features on different imaging modalities and how to correlate these findings with urine studies and histologic analysis to definitively diagnose genitourinary TB.
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Affiliation(s)
- Ahmed Radwan
- University of Texas MD Anderson Cancer Center, Houston, TX.
| | | | - Mohamed T El-Diasty
- Radiology department, King AbdulAziz University Hospital, Jeddah, Saudi Arabia
| | | | | | | | - Sameh Nassar
- University of Texas MD Anderson Cancer Center, Houston, TX
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10
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Wearne N, Davidson B, Blockman M, Swart A, Jones ES. HIV, drugs and the kidney. Drugs Context 2020; 9:dic-2019-11-1. [PMID: 32256631 PMCID: PMC7104683 DOI: 10.7573/dic.2019-11-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/18/2020] [Accepted: 02/11/2020] [Indexed: 12/20/2022] Open
Abstract
Human immunodeficiency virus (HIV) affects over 36 million people worldwide. Antiretroviral therapy (ART) is expanding and improving HIV viral suppression, resulting in increasing exposure to drugs and drug interactions. Polypharmacy is a common complication as people are living longer on ART, increasing the risk of drug toxicities. Polypharmacy is related not only to ART exposure and medication for opportunistic infections, but also to treatment of chronic lifestyle diseases. Acute kidney injury (AKI) is frequent in HIV and is commonly the result of sepsis, dehydration and drug toxicities. Furthermore, HIV itself increases the risk of chronic kidney disease (CKD). Drug treatment is often complicated in people living with HIV because of a greater incidence of AKI and/or CKD compared to the HIV-negative population. Impaired renal function affects drug interactions, drug toxicities and importantly drug dosing, requiring dose adjustment. This review discusses ART and its nephrotoxic effects, including drug–drug interactions. It aims to guide the clinician on dose adjustment in the setting of renal impairment and dialysis, for the commonly used drugs in patients with HIV.
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Affiliation(s)
- Nicola Wearne
- Groote Schuur Hospital Department of Medicine, Division of Nephrology and Hypertension, Nephrology and Hypertension Research Unit, University of Cape Town, South Africa
| | - Bianca Davidson
- Groote Schuur Hospital Department of Medicine, Division of Nephrology and Hypertension, Nephrology and Hypertension Research Unit, University of Cape Town, South Africa
| | - Marc Blockman
- Groote Schuur Hospital Department of Medicine, Division of Clinical Pharmacology, University of Cape Town, South Africa
| | - Annoesjka Swart
- Groote Schuur Hospital Department of Medicine, Division of Clinical Pharmacology, University of Cape Town, South Africa
| | - Erika Sw Jones
- Groote Schuur Hospital Department of Medicine, Division of Nephrology and Hypertension, Nephrology and Hypertension Research Unit, University of Cape Town, South Africa
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11
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Mba B, Lucas BP, Houchens N, Seares JM, Joshi U. All in the Stream. J Hosp Med 2019; 14:777-781. [PMID: 31532744 PMCID: PMC6897536 DOI: 10.12788/jhm.3286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/25/2019] [Accepted: 07/08/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Benjamin Mba
- Department of Medicine, John H. Stroger Hospital of Cook County, Chicago, Illinois
| | - Brian P Lucas
- Department of Medicine, White River Junction Veterans Affairs Medical Center, White River Junction, Vermont
| | - Nathan Houchens
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Udit Joshi
- Department of Medicine, John H. Stroger Hospital of Cook County, Chicago, Illinois
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12
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Adjei DN, Stronks K, Adu D, Beune E, Meeks K, Smeeth L, Addo J, Owuso-Dabo E, Klipstein-Grobusch K, Mockenhaupt FP, Schulze MB, Danquah I, Spranger J, Bahendeka S, de-Graft Aikins A, Agyemang C. Chronic kidney disease burden among African migrants in three European countries and in urban and rural Ghana: the RODAM cross-sectional study. Nephrol Dial Transplant 2019; 33:1812-1822. [PMID: 29342308 DOI: 10.1093/ndt/gfx347] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 12/03/2017] [Indexed: 11/13/2022] Open
Abstract
Background Chronic kidney disease (CKD) is a major burden among sub-Saharan African (SSA) populations. However, differences in CKD prevalence between rural and urban settings in Africa, and upon migration to Europe are unknown. We therefore assessed the differences in CKD prevalence among homogenous SSA population (Ghanaians) residing in rural and urban Ghana and in three European cities, and whether conventional risk factors of CKD explained the observed differences. Furthermore, we assessed whether the prevalence of CKD varied among individuals with hypertension and diabetes compared with individuals without these conditions. Methods For this analysis, data from Research on Obesity & Diabetes among African Migrants (RODAM), a multi-centre cross-sectional study, were used. The study included a random sample of 5607 adult Ghanaians living in Europe (1465 Amsterdam, 577 Berlin, 1041 London) and Ghana (1445 urban and 1079 rural) aged 25-70 years. CKD status was defined according to severity of kidney disease using the combination of glomerular filtration rate (G1-G5) and albuminuria (A1-A3) levels as defined by the 2012 Kidney Disease: Improving Global Outcomes severity classification. Comparisons among sites were made using logistic regression analysis. Results CKD prevalence was lower in Ghanaians living in Europe (10.1%) compared with their compatriots living in Ghana (13.3%) even after adjustment for age, sex and conventional risk factors of CKD [adjusted odds ratio (OR) = 0.70, 95% confidence interval (CI) 0.56-0.88, P = 0.002]. CKD prevalence was markedly lower among Ghanaian migrants with hypertension (adjusted OR = 0.54, 0.44-0.76, P = 0.001) and diabetes (adjusted OR = 0.37, 0.22-0.62, P = 0.001) compared with non-migrant Ghanaians with hypertension and diabetes. No significant differences in CKD prevalence was observed among non-migrant Ghanaians and migrant Ghanaians with no hypertension and diabetes. Among Ghanaian residents in Europe, the odds of CKD were lower in Amsterdam than in Berlin, while among Ghanaian residents in Ghana, the odds of CKD were lower in rural Ghana (adjusted OR = 0.68, 95% CI 0.53-0.88, P = 0.004) than in urban Ghana, but these difference were explained by conventional risk factors. Conclusion Our study shows important differences in CKD prevalence among Ghanaians living in Europe compared with those living in Ghana, independent of conventional risk factors, with marked differences among those with hypertension and diabetes. Further research is needed to identify factors that might explain the observed difference across sites to implement interventions to reduce the high burden of CKD, especially in rural and urban Ghana.
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Affiliation(s)
- David N Adjei
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands.,Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Karien Stronks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Dwomoa Adu
- Department of Medicine, School of Medicine and Dentistry, University of Ghana and Korle-Bu Teaching Hospital, Accra, Ghana
| | - Erik Beune
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Karlijn Meeks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Liam Smeeth
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Juliet Addo
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Frank P Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité - University Medicine Berlin, Berlin, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - Ina Danquah
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - Joachim Spranger
- Department of Endocrinology and Metabolism, Charité-University Medicine Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Berlin, Germany.,Center for Cardiovascular Research (CCR), Charité - University Medicine Berlin, Berlin, Germany
| | | | - Ama de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, Legon, Ghana
| | - Charles Agyemang
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
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13
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Complicated Urinary Tract Tuberculosis in a 13-Year-Old Adolescent with Chronic Kidney Disease and Antituberculous Drug-Induced Hepatotoxicity. Case Rep Infect Dis 2019; 2019:7370150. [PMID: 31781434 PMCID: PMC6855035 DOI: 10.1155/2019/7370150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 08/29/2019] [Indexed: 11/17/2022] Open
Abstract
Urinary tract tuberculosis (TB) is a rare extrapulmonary manifestation of TB in children. The disease is potentially underdiagnosed because it clinically resembles other urinary tract infections. A 13-year-old adolescent girl presented with pain, difficulty in micturition, and gross hematuria for almost two years before admission, and she had left flank pain since one year ago and significant loss of body weight during the illness. The close TB contact was her grandmother who was on TB treatment. Acid-fast bacilli yielded positive result, Mantoux test was positive (17 mm), urine GeneXpert MTB/Rif was positive; tuberculoma was identified on kidney histopathology, and a diuretic renogram revealed an uncorrected glomerular filtration rate (GFR) of the right and left kidney to be 32.5 mL/min/1.73 m2 and 5 mL/min/1.73 m2, respectively. During the treatment, oral anti-TB drug-induced hepatotoxicity (ADIH) occurred to the patient. This problem was solved with management according to the British Thoracic Society (BTS) guidelines. Screening TB in children is very important for a better outcome. If children complain of some complicated urinary tract infection, TB should be suspected. Optimaly treating children with urinary tract TB exagerrated with ADIH and CKD is very challenging.
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Urogenital tuberculosis - epidemiology, pathogenesis and clinical features. Nat Rev Urol 2019; 16:573-598. [PMID: 31548730 DOI: 10.1038/s41585-019-0228-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2019] [Indexed: 02/07/2023]
Abstract
Tuberculosis (TB) is the most common cause of death from infectious disease worldwide. A substantial proportion of patients presenting with extrapulmonary TB have urogenital TB (UG-TB), which can easily be overlooked owing to non-specific symptoms, chronic and cryptic protean clinical manifestations, and lack of clinician awareness of the possibility of TB. Delay in diagnosis results in disease progression, irreversible tissue and organ damage and chronic renal failure. UG-TB can manifest with acute or chronic inflammation of the urinary or genital tract, abdominal pain, abdominal mass, obstructive uropathy, infertility, menstrual irregularities and abnormal renal function tests. Advanced UG-TB can cause renal scarring, distortion of renal calyces and pelvic, ureteric strictures, stenosis, urinary outflow tract obstruction, hydroureter, hydronephrosis, renal failure and reduced bladder capacity. The specific diagnosis of UG-TB is achieved by culturing Mycobacterium tuberculosis from an appropriate clinical sample or by DNA identification. Imaging can aid in localizing site, extent and effect of the disease, obtaining tissue samples for diagnosis, planning medical or surgical management, and monitoring response to treatment. Drug-sensitive TB requires 6-9 months of WHO-recommended standard treatment regimens. Drug-resistant TB requires 12-24 months of therapy with toxic drugs with close monitoring. Surgical intervention as an adjunct to medical drug treatment is required in certain circumstances. Current challenges in UG-TB management include making an early diagnosis, raising clinical awareness, developing rapid and sensitive TB diagnostics tests, and improving treatment outcomes.
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Schmidt-Lauber C, Jacobi J, Polifka I, Hilgers KF, Wiesener MS. Suspected colonic cancer turns out to be disseminated tuberculosis in a kidney transplant recipient: A case report. Medicine (Baltimore) 2019; 98:e16995. [PMID: 31490381 PMCID: PMC6738975 DOI: 10.1097/md.0000000000016995] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
RATIONALE Active tuberculosis constitutes a relevant risk for kidney transplant recipients. In contrast to immunocompetent hosts, kidney transplant recipients often show atypical presentation and course of the disease impeding diagnosis. Especially extrapulmonary or disseminated infection is more frequent and can resemble malignant processes. However, reactivation of tuberculosis mostly develops within the early post-transplant course, whereas malignancies are predominantly long-term complications. We report a case of disseminated abdominal tuberculosis developing 10 years after kidney transplantation and review the underlying literature. PATIENT CONCERNS AND DIAGNOSES A 51-year-old lady presented with epigastric pain, diarrhea, weight loss and night sweats 10 years after deceased-donor kidney transplantation. An epigastric as well as multiple peritoneal masses were found suspicious of a cancer of unknown primary. Colonoscopy revealed a colon tumor with the biopsy showing no dysplasia but histiocytic and granulomatous infiltration with acid-fast bacilli. Mycobacterium tuberculosis was detected in the biopsy and stool and disseminated abdominal tuberculosi was diagnosed. INTERVENTIONS AND OUTCOMES With anti-tuberculosis therapy, the masses regressed, and all cultures became sterile, sparing graft function. LESSONS This case emphasizes how variable and unspecific the presentation of tuberculosis in kidney transplant recipients may be and that tuberculosis constitutes a relevant risk also in the long-term post-transplant course.
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Affiliation(s)
| | | | - Iris Polifka
- Department of Pathology, University of Erlangen-Nürnberg, Erlangen, Germany
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Beaumier M, Roger H, Sauneuf B, Dugardin F, Camparo P, Queffeulou G. Tuberculose disséminée révélée par une insuffisance rénale aiguë obstructive et fonctionnelle. Nephrol Ther 2019; 15:169-173. [DOI: 10.1016/j.nephro.2019.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 01/25/2019] [Accepted: 01/30/2019] [Indexed: 10/26/2022]
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Malakar S, Negi BD, Singh G, Sharma T. Nephrocalcinosis in a patient with extrapulmonary tuberculosis - A rare entity. J Family Med Prim Care 2019; 8:296-298. [PMID: 30911525 PMCID: PMC6396576 DOI: 10.4103/jfmpc.jfmpc_385_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Nephrocalcinosis is a rare condition in clinical practice where there is an increased renal deposition of calcium. Varied causes of this condition have been given in literature, and tuberculosis (TB) has been an important one. Hypercalcemia is a known complication of granulomatous diseases. We report a rare case explicitly showing relationship of extrapulmonary (genitourinary) TB with nephrocalcinosis.
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Affiliation(s)
- Sayan Malakar
- Department of Medicine, RPGMC Tanda at Kangra, Himachal Pradesh, India
| | - Bhagwan Dass Negi
- Department of Medicine, RPGMC Tanda at Kangra, Himachal Pradesh, India
| | - Guriqbal Singh
- Department of Medicine, RPGMC Tanda at Kangra, Himachal Pradesh, India
| | - Tarun Sharma
- Department of Medicine, RPGMC Tanda at Kangra, Himachal Pradesh, India
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18
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Zellweger JP, Sousa P, Heyckendorf J. Clinical diagnosis of tuberculosis. Tuberculosis (Edinb) 2018. [DOI: 10.1183/2312508x.10021017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gagne SM, Newbury A, Nowitzki KM, Chen BY, Lo HS. Name That Nephrogram: Asymmetric Renal Enhancement in the Acute Care Setting. Curr Probl Diagn Radiol 2018; 48:616-625. [PMID: 30415790 DOI: 10.1067/j.cpradiol.2018.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/06/2018] [Accepted: 10/16/2018] [Indexed: 12/23/2022]
Abstract
Disorders of the kidney and urinary collecting system are common encountered in the acute care setting. Computed tomography has progressively replaced intravenous pyelography for the evaluation of most urinary tract pathology including acute flank pain, suspected malignancy, congenital abnormalities, anatomical variants, and inflammatory/vascular conditions through evaluation of the "nephrogram" produced by intravenous contrast material filtering through the kidneys. In this review, we describe the most common types of abnormal nephrograms seen on renal computed tomography, and highlight the salient features and conditions associated with them, in addition to a pictorial review with specific and interesting related cases. The types of abnormal nephrograms reviewed are absent, unilateral delayed, striated, spotted, and persistent.
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Affiliation(s)
- Staci M Gagne
- University of Massachusetts Medical School, Department of Radiology, Worcester, MA
| | - Alex Newbury
- University of Massachusetts Medical School, Department of Radiology, Worcester, MA
| | - Kristina M Nowitzki
- University of Massachusetts Medical School, Department of Radiology, Worcester, MA
| | - Byron Y Chen
- University of Massachusetts Medical School, Department of Radiology, Worcester, MA
| | - Hao S Lo
- University of Massachusetts Medical School, Department of Radiology, Worcester, MA..
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21
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Abstract
Immunoglobulin A nephropathy (IgAN) is the most frequent pathological diagnosis of tuberculosis (TB)-associated glomerulonephritis. Diagnosing TB-associated IgAN (TB-IgAN) is difficult because of its non-specific and insidious symptoms. An inaccurate diagnosis of TB-IgAN could result in the spread of TB and reduced renal function. Haematuria and proteinuria in conjunction with TB should be assessed because of the potential for diagnosis of IgAN. Renal biopsy is important in securing an accurate diagnosis prior to initiating treatment. Detection of Mycobacterium tuberculosis DNA and assessment of early secreted antigenic target of 6 kDa in renal biopsy tissues may have great potential diagnostic value in patients with TB-IgAN. Anti-TB therapy can effectively alleviate TB and TB-IgAN.
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Affiliation(s)
- Yamei Wang
- 1 Department of Pediatrics, West China Second University Hospital, Sichuan University, Sichuan Province, China.,2 Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
| | - Yuhong Tao
- 1 Department of Pediatrics, West China Second University Hospital, Sichuan University, Sichuan Province, China
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Classics in abdominal imaging: the putty kidney. Abdom Radiol (NY) 2018; 43:1510-1512. [PMID: 28936724 DOI: 10.1007/s00261-017-1324-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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23
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Correa V, Vintch J, Lanks C. A 26-Year-Old Man From Mexico With Headaches, Dysuria, and a Right Scrotal Mass. Chest 2017; 152:e147-e150. [PMID: 29223275 DOI: 10.1016/j.chest.2017.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 07/31/2017] [Accepted: 08/03/2017] [Indexed: 11/26/2022] Open
Abstract
CASE PRESENTATION A 26-year-old man with no medical history was admitted to the hospital for evaluation of his change in mental status. He was noted to be agitated at work and had difficulty walking for 2 days before being brought in to the ED by his family. According to his uncle, the patient had been complaining of a headache and pain with urination for approximately 1 week. He was born in Guerrero, Mexico (a small farm town), and moved to Los Angeles, California, in 2008.
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Affiliation(s)
- Vanessa Correa
- Division of Pulmonary and Critical Care Physiology and Medicine, Harbor-UCLA Medical Center, Torrance, CA
| | - Janine Vintch
- Division of Pulmonary and Critical Care Physiology and Medicine, Harbor-UCLA Medical Center, Torrance, CA
| | - Charles Lanks
- Division of Pulmonary and Critical Care Physiology and Medicine, Harbor-UCLA Medical Center, Torrance, CA.
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Abstract
Tuberculous pyelonephritis is rare in children; three case reports are presented. Case 1 was an 11-year-old girl with a previous history of pulmonary tuberculosis who presented with flank pain and fever for 10 days. An ultrasound suggested focal pyelonephritis, and a contrast-enhanced computed tomography (CECT) scan demonstrated acute focal pyelonephritis and a perinephric collection. Mycobacterium tuberculosis was cultured in the urine. She responded well to anti-tuberculous treatment (ATT). Case 2 was a 13-year-old boy who presented with fever, haematuria, burning micturition, proteinuria (3+) and cervical lymphadenopathy. The Mantoux test was strongly positive. Chest radiograph demonstrated right hilar lymphadenopathy and ultrasonography showed evidence of acute pyelonephritis. Tuberculous lymphadenitis was diagnosed by fine-needle aspiration cytology (FNAC) from cervical lymph nodes and he responded to ATT. Follow-up urinalysis and ultrasound were normal. Case 3 was a 6-year-old boy, a known case of pulmonary tuberculosis (from 2 years of age) and a previous defaulter from ATT. He presented with symptoms of lumbar pain and dysuria. Chest radiograph demonstrated mediastinal lymphadenopathy and a CECT of the head showed a tuberculous granuloma. CECT of the abdomen showed an enlarged left kidney with focal pyelonephritis, an abscess in the upper pole and parenchymal calcification. FNAC of the cervical lymph nodes supported a diagnosis of disseminated tuberculosis with tuberculous pyelonephritis. He was given 8 months of ATT. Fifteen months later he presented again with clinical and urinary findings of urinary tract infection. CECT now demonstrated gross hydronephrosis of the left kidney, and it was confirmed to be non-functioning by a DMSA scan and magnetic resonance urogram. Diethylenetriaminepentaacetic acid showed a GFR of 44.3 ml/min/1.73 m2. Nephrectomy was undertaken and the histology confirmed tuberculous pyelonephritis. Six months later he was well with an eGFR of 87.2 ml/min/m2. In patients with symptoms of urinary tract infection but sterile urine who do not respond to antibiotics or have evidence of tuberculous elsewhere in the body, careful consideration should be given to the possibility of tuberculous pyelonephritis.
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Affiliation(s)
- Nimisha Arora
- a Division of Pediatric Nephrology, Department of Pediatrics , Lady Hardinge Medical College and Associated Kalawati Saran Children Hospital , New Delhi , India
| | - Abhijeet Saha
- a Division of Pediatric Nephrology, Department of Pediatrics , Lady Hardinge Medical College and Associated Kalawati Saran Children Hospital , New Delhi , India
| | - Manpreet Kaur
- b Division of Pediatric Nephrology, Department of Pediatrics , Postgraduate Institute of Medical Education & Research and Associated Dr. Ram Manohar Lohia Hospital , New Delhi , India
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Majeed NK, Acosta AM, Kajdacsy-Balla A, Setty S, Aardsma NA. Granulomas within renal epithelial neoplasms in patients with sarcoidosis: A causal association? Pathol Res Pract 2017; 213:1431-1434. [PMID: 28780082 DOI: 10.1016/j.prp.2017.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 07/01/2017] [Accepted: 07/19/2017] [Indexed: 11/24/2022]
Abstract
Sarcoidosis is a chronic granulomatous disease that can involve virtually every organ system, but most commonly presents as lung, skin, or lymph node disease. Although kidney involvement is usually clinically silent, granulomatous interstitial nephritis - the hallmark of renal sarcoidosis - can lead to functional impairment and organ failure. Also, recent studies have suggested an association between sarcoidosis and an increased risk of developing kidney tumors. While a sarcoid-like granulomatous reaction (SLGR) to renal epithelial neoplasms in patients without sarcoidosis has been well documented, direct involvement of the tumor parenchyma by sarcoidosis has been reported only rarely. Here we present two renal epithelial tumors directly involved by sarcoidosis with a common pattern of distribution of non-caseating granulomas.
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Affiliation(s)
- Nasma K Majeed
- Surgical Pathology Division, Department of Pathology, University of Illinois at Chicago, 840 S. Wood St., Suite 130 CSN, Chicago, IL, 60612, United States
| | - Andres M Acosta
- Surgical Pathology Division, Department of Pathology, University of Illinois at Chicago, 840 S. Wood St., Suite 130 CSN, Chicago, IL, 60612, United States.
| | - Andre Kajdacsy-Balla
- Surgical Pathology Division, Department of Pathology, University of Illinois at Chicago, 840 S. Wood St., Suite 130 CSN, Chicago, IL, 60612, United States
| | - Suman Setty
- Surgical Pathology Division, Department of Pathology, University of Illinois at Chicago, 840 S. Wood St., Suite 130 CSN, Chicago, IL, 60612, United States
| | - Nathan A Aardsma
- Surgical Pathology Division, Department of Pathology, University of Illinois at Chicago, 840 S. Wood St., Suite 130 CSN, Chicago, IL, 60612, United States; Hematologic Pathology Division, Department of Pathology, University of Illinois at Chicago, 840 S. Wood St., Suite 130 CSN, Chicago, IL, 60612, United States
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26
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Steinkeler JA, Sun MRM. Imaging of Infections of the Urinary and Male Reproductive Tracts. Semin Roentgenol 2017; 52:83-89. [PMID: 28606312 DOI: 10.1053/j.ro.2016.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Maryellen R M Sun
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA.
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Ghosh B, Sridhar K, Pal DK. Laparoscopic Reconstruction in Post-Tubercular Urinary Tract Strictures: Technical Challenges. J Laparoendosc Adv Surg Tech A 2017; 27:1121-1126. [PMID: 28488946 DOI: 10.1089/lap.2016.0609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Genitourinary tuberculosis still continues to plague developing countries and is a significant cause of morbidity as well as mortality in the developing world. At present, nearly 55% of the patients of genitourinary tuberculosis (GUTB) need surgical management. Owing to the presence of dense adhesions and loss of normal anatomical planes, GUTB was considered to be a contraindication to laparoscopic surgery. However, recent literature shows laparoscopy to be feasible in GUTB. Our study aimed at identifying the challenges in laparoscopic urinary tract reconstructive surgery in genitourinary tuberculosis-related urinary tract obstruction. MATERIALS AND METHODS The details of 6 patients who underwent different types of laparoscopic reconstructive surgery for genitourinary tuberculosis-related urinary tract obstruction from January 2014 to December 2015 were reviewed. Baseline characteristics, indications of surgery, type of surgery, operative duration, blood loss, and follow-up details were noted. All patients received antitubercular treatment before surgery as per the direct observed treatment short-course regimen followed in our country. RESULTS We performed one bilateral laparoscopic pyeloplasty, one unilateral laparoscopic pyeloplasty, two laparoscopic ureteroneocystostomies, and two ureteroureterostomies. Difficulty was encountered during dissection owing to the presence of adhesions, but conversion to open surgery was not done in five cases. Dense adhesions adjacent to the common iliac vessels necessitated conversion to open surgery in one of the ureteroureterostomies. Stenting was done in all the patients. All patients had uneventful postoperative recovery. Functional imaging following stent removal showed unobstructed tracer flow, showing successful operative outcome. CONCLUSIONS Our study showed that laparoscopic reconstructive surgery is feasible in genitourinary tuberculosis despite the presence of adhesions that may pose a challenge to dissection. This is in contrast to the previous studies which conclude that genitourinary tuberculosis is a relative contraindication to laparoscopic surgery.
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Affiliation(s)
- Bastab Ghosh
- Department of Urology, Institute of Post Graduate Medical Education and Research , Kolkata, India
| | - Kartik Sridhar
- Department of Urology, Institute of Post Graduate Medical Education and Research , Kolkata, India
| | - Dilip Kumar Pal
- Department of Urology, Institute of Post Graduate Medical Education and Research , Kolkata, India
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28
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Clause AL, Aydin S, Jadoul M, Morelle J. Quiz: Acute Kidney Injury in a Patient on a TNF-α Blocking Agent. Am J Kidney Dis 2017; 69:A8-A11. [PMID: 28340853 DOI: 10.1053/j.ajkd.2016.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 12/27/2016] [Indexed: 11/11/2022]
Affiliation(s)
| | - Selda Aydin
- Department of Pathology, Cliniques universitaires Saint-Luc, Brussels, Belgium; Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Michel Jadoul
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium; Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Johann Morelle
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium; Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.
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Oliveira B, Jayawardene S, Shah S. Single-centre experience of granulomatous interstitial nephritis-time for a new approach? Clin Kidney J 2017; 10:249-254. [PMID: 28396742 PMCID: PMC5381231 DOI: 10.1093/ckj/sfw119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 09/22/2016] [Accepted: 10/10/2016] [Indexed: 11/13/2022] Open
Abstract
Background: Differentiating between renal-limited sarcoidosis and tuberculosis (TB) infection as a cause of granulomatous interstitial nephritis (GIN) can be difficult. This series compares clinical features and response to treatment between the different underlying aetiologies in order to propose a management algorithm for GIN to assist with diagnosis and treatment. Methods: This retrospective study reports on all patients presenting with a histological diagnosis of GIN between 2000 and 2012 at our unit. Results: Twenty-one patients were identified, 57% were male and the mean age was 53 years. Eight cases were associated with sarcoidosis with evidence of extra-renal disease and five with renal-limited sarcoidosis. Five patients had GIN that may have been related to TB infection or to renal-limited sarcoidosis, and three were idiopathic or drug related. All those with sarcoidosis were treated with steroids and renal function, as measured by estimated glomerular filtration rate (eGFR), improved from a mean of 24 mL/min at baseline to 37 mL/min at 1 year. Baseline eGFR was 19 mL/min in those with possible TB infection. Four received steroids as well as anti-TB drugs. Anti-TB therapy was delayed in four patients by a mean of 22 months due to difficulties in diagnosis. Two patients with TB developed end-stage kidney disease and the remaining three patients had a mean eGFR of 28 mL/min at 1 year. Conclusions: This series represents the largest cohort of patients with GIN in the UK and supports previous findings that patients with sarcoid have a favourable outcome with steroid treatment. Those with TB have an inferior prognosis, perhaps due to delayed diagnosis. We suggest an algorithm when investigating a diagnosis of GIN with the aim of expediting diagnosis and considering a trial of anti-TB therapy in order to prevent deterioration of renal function.
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Affiliation(s)
| | | | - Sapna Shah
- Renal Unit, King's College Hospital, London, UK
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Shiratori B, Zhao J, Okumura M, Chagan-Yasutan H, Yanai H, Mizuno K, Yoshiyama T, Idei T, Ashino Y, Nakajima C, Suzuki Y, Hattori T. Immunological Roles of Elevated Plasma Levels of Matricellular Proteins in Japanese Patients with Pulmonary Tuberculosis. Int J Mol Sci 2016; 18:ijms18010019. [PMID: 28025511 PMCID: PMC5297654 DOI: 10.3390/ijms18010019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 12/16/2016] [Accepted: 12/16/2016] [Indexed: 01/17/2023] Open
Abstract
Elevated matricellular proteins (MCPs), including osteopontin (OPN) and galectin-9 (Gal-9), were observed in the plasma of patients with Manila-type tuberculosis (TB) previously. Here, we quantified plasma OPN, Gal-9, and soluble CD44 (sCD44) by enzyme-linked immunosorbent assay (ELISA), and another 29 cytokines by Luminex assay in 36 patients with pulmonary TB, six subjects with latent tuberculosis (LTBI), and 19 healthy controls (HCs) from Japan for a better understanding of the roles of MCPs in TB. All TB subjects showed positive results of enzyme-linked immunospot assays (ELISPOTs). Spoligotyping showed that 20 out of 36 Mycobacterium tuberculosis (MTB) strains belong to the Beijing type. The levels of OPN, Gal-9, and sCD44 were higher in TB (positivity of 61.1%, 66.7%, and 63.9%, respectively) than in the HCs. Positive correlations between OPN and Gal-9, between OPN and sCD44, and negative correlation between OPN and ESAT-6-ELISPOT response, between chest X-ray severity score of cavitary TB and ESAT-6-ELISPOT response were observed. Instead of OPN, Gal-9, and sCD44, cytokines G-CSF, GM-CSF, IFN-α, IFN-γ, IL-12p70, and IL-1RA levels were higher in Beijing MTB-infected patients. These findings suggest immunoregulatory, rather than inflammatory, effect of MCPs and can advance the understanding of the roles of MCPs in the context of TB pathology.
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Affiliation(s)
- Beata Shiratori
- Division of Disaster-Related Infectious Diseases, International Research Institute of Disaster Science, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan.
| | - Jingge Zhao
- Division of Disaster-Related Infectious Diseases, International Research Institute of Disaster Science, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan.
| | - Masao Okumura
- Department of Respiratory Medicine, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 3-1-24 Matsuyama, Kiyose, Tokyo 204-8533, Japan.
| | - Haorile Chagan-Yasutan
- Division of Disaster-Related Infectious Diseases, International Research Institute of Disaster Science, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan.
| | - Hideki Yanai
- Department of Clinical Laboratory, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 3-1-2 4 Matsuyama, Kiyose, Tokyo 204-8533, Japan.
| | - Kazue Mizuno
- Department of Clinical Laboratory, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 3-1-2 4 Matsuyama, Kiyose, Tokyo 204-8533, Japan.
| | - Takashi Yoshiyama
- Department of Respiratory Medicine, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 3-1-24 Matsuyama, Kiyose, Tokyo 204-8533, Japan.
| | - Tadashi Idei
- Department of Clinical Laboratory, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 3-1-2 4 Matsuyama, Kiyose, Tokyo 204-8533, Japan.
| | - Yugo Ashino
- Division of Disaster-Related Infectious Diseases, International Research Institute of Disaster Science, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan.
| | - Chie Nakajima
- Division of Global Epidemiology, Research Center for Zoonosis Control, Hokkaido University, North 20, West 10, Kita-ku, Sapporo, Hokkaido 001-0020, Japan.
| | - Yasuhiko Suzuki
- Division of Global Epidemiology, Research Center for Zoonosis Control, Hokkaido University, North 20, West 10, Kita-ku, Sapporo, Hokkaido 001-0020, Japan.
| | - Toshio Hattori
- Department of Health Science and Social Welfare, Kibi International University, 8 Igamachi, Takahashi 716-8508, Japan.
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Tropical Diseases Nephropathy - An Underemphasized Comorbidity. ARS MEDICA TOMITANA 2016. [DOI: 10.1515/arsm-2016-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractThe tropical areas are a home to a number of diseases because of the hot & humid climate, and lack of health care facilities. Tropical Nephropathies are a major health problem and a matter of great concern. The main causes of kidney injury in tropics are due to bacterial, viral or parasitic infections like malaria, dengue, leptospirosis, scrub typhus, acute gastroenteritis, tuberculosis, leprosy and toxic envenomations like snake bite. Renal injury associated with tropical infections has a wide spectrum of presentations ranging from acute kidney injury to chronic kidney disease. Renal involvement in infectious diseases by one or other mechanism is a definite cause of increased morbidity and mortality. Proper understanding of these diseases, early diagnosis, patient education and improved health care facilities will lead to a better outcome and improved survival. This article reviews the various tropical infections causing kidney injury including pathophysiology and line of management.
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Verma AK, Mishra AK, Kumar M, Kant S, Singh A, Singh A. Renal tuberculosis presenting as acute pyelonephritis – A rarity. ACTA ACUST UNITED AC 2016; 63:210-213. [DOI: 10.1016/j.ijtb.2015.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 06/19/2015] [Accepted: 07/13/2015] [Indexed: 11/25/2022]
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Silva Junior GBD, Brito LDS, Rabelo STDO, Saboia ZMRMD. Chronic kidney disease related to renal tuberculosis: a case report. Rev Soc Bras Med Trop 2016; 49:386-8. [DOI: 10.1590/0037-8682-0310-2015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/19/2015] [Indexed: 05/29/2023] Open
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Jha V, Prasad N. CKD and Infectious Diseases in Asia Pacific: Challenges and Opportunities. Am J Kidney Dis 2016; 68:148-60. [PMID: 26943982 DOI: 10.1053/j.ajkd.2016.01.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 01/15/2016] [Indexed: 02/06/2023]
Abstract
The exact number of patients with chronic kidney disease (CKD) in Asia Pacific is uncertain. In numeric terms, the region is home to the largest population of patients with untreated chronic kidney failure. The climatic, geographic, social, cultural, economic, and environmental diversity within this region is higher than in any other part of the world. Large parts of the region face a climate-related burden of infectious diseases. Infections contribute to the development and progression of CKD and complicate the course of patients with pre-existing CKD (especially those on dialysis therapy or who are immunosuppressed), increase the cost of CKD care, and contribute to mortality and morbidity. Kidney involvement is a feature of several infectious diseases prevalent in Asia Pacific. Examples include malaria, leptospirosis, scrub typhus, tuberculosis, hepatitis B and C virus, dengue hemorrhagic fever, and Hantaan virus infections. The contribution of infection-associated acute kidney injury to the overall burden of CKD has not been evaluated systematically. Research is needed to quantify the impact of infections on kidney health by undertaking prospective studies. Nephrologists need to work with infectious disease research groups and government infection surveillance and control programs.
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Affiliation(s)
- Vivekanand Jha
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India; Department of Nephrology, George Institute for Global Health, New Delhi, India; Department of Nephrology, University of Oxford, Oxford, United Kingdom.
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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An Unusual Cause of Dysuria in a 30-Year-Old Woman. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2016. [DOI: 10.1097/ipc.0000000000000322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kanodia KV, Vanikar AV, Patel RD, Suthar KS, Trivedi HL. Crescentic Glomerulonephritis Associated with Pulmonary Tuberculosis. J Clin Diagn Res 2016; 10:ED01-2. [PMID: 26894074 DOI: 10.7860/jcdr/2016/14191.6970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 09/03/2015] [Indexed: 11/24/2022]
Abstract
Tuberculosis of kidney and urinary tract is caused by members of the Mycobacterium tuberculosis complex. Kidney is usually infected by haematogenous spread of bacilli from focus of infection in the lungs. Glomerular involvement in tuberculosis presenting as a rapidly progressive glomerulonephritis is a rare entity. We report a rare case of crescentic glomerulonephritis associated with pulmonary tuberculosis in a 26-year-old man. Patient was treated with corticosteroids, haemodialysis, intravenous immunoglobulin and four cycles of plasmapheresis. He did not respond to 4-drug anti-tuberculosis treatment for renal pathology and was switched over to maintenance haemodialysis. However, he responded to pulmonary TB.
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Affiliation(s)
- K V Kanodia
- Professor, Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, G.R. Doshi and K.M. Mehta Institute of Kidney Diseases & Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences , Civil Hospital Campus, Asarwa, Ahmedabad, India
| | - A V Vanikar
- Professor and Head, Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, G.R. Doshi and K.M. Mehta Institute of Kidney Diseases & Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences , Civil Hospital Campus, Asarwa, Ahmedabad, India
| | - R D Patel
- Professor, Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, G.R. Doshi and K.M. Mehta Institute of Kidney Diseases & Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences , Civil Hospital Campus, Asarwa, Ahmedabad, India
| | - K S Suthar
- Assistant Professor, Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, G.R. Doshi and K.M. Mehta Institute of Kidney Diseases & Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences , Civil Hospital Campus, Asarwa, Ahmedabad, India
| | - H L Trivedi
- Professor, Department of Nephrology and Transplantation Medicine and Director, G.R. Doshi and K.M. Mehta Institute of Kidney Diseases & Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences , Civil Hospital Campus, Asarwa, Ahmedabad, India
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Santra A, Mandi F, Bandyopadhyay A. Renal Tuberculosis Presenting as a Mass Lesion in a Two-year-old Girl: Report of a rare case. Sultan Qaboos Univ Med J 2016; 16:e105-8. [PMID: 26909199 DOI: 10.18295/squmj.2016.16.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/04/2015] [Accepted: 09/17/2015] [Indexed: 11/16/2022] Open
Abstract
Genitourinary tuberculosis usually occurs in young adults and the middle-aged and is very uncommon in the paediatric population. It generally presents with haematuria, pyuria, irritative voiding symptoms and flank pain; presentation as a renal mass is highly unusual. We report a two-year-old girl who was referred to the Nil Ratan Sircar Medical College, Kolkata, India, in June 2014 with abdominal pain. Subsequent radiological investigations revealed a left renal hypoechoic mass lesion. A left nephroureterectomy was performed on suspicion of a Wilms' tumour. Histopathology indicated an epithelioid granuloma with lymphocytic infiltration, suggestive of a tubercular aetiology. A Mantoux tuberculin skin test was positive; however, there was no evidence of tuberculosis detected elsewhere in the body and the source of the infection could not be identified. A diagnosis of renal tuberculosis was made and the child was treated with antitubercular drugs. The patient was asymptomatic at a six-month follow-up.
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Affiliation(s)
- Avradip Santra
- Departments of Chest Medicine, Nil Ratan Sircar Medical College, Kolkata, India
| | - Falguni Mandi
- Departments of Chest Medicine, Nil Ratan Sircar Medical College, Kolkata, India
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Abstract
BACKGROUND Miliary tuberculosis (TB) usually presents with atypical clinical manifestations; thus it is often recognized only at autopsy. OBJECTIVES Our objectives were to study the frequency of MT diagnosed at autopsy and determine clinical diagnoses that masked TB, as well as causes of death and comorbidities. DESIGN Retrospective study of all autopsies performed between 2008 and 2014. SETTING Institute of Pathology, Belgrade, Serbia. SUBJECTS AND METHODS in subjects where autopsy showed the presence of MT that was not recognized clinically, we recorded the clinical diagnoses (presumed causes of death) as reported in autopsy request forms, as well as actual cause of death and comorbidities as determined at autopsy. MAIN OUTCOME MEASURES Clinically unrecognized MT. RESULTS The total number of autopsies in this period was 6206. thirty-five individuals showed clinically unrecognized MT (0.56% of all autopsies, age: 62.2 [17.2] years, M:F=2:3). Common clinical diagnoses masking pulmonary MT were exacerbation of COPD (25%) and pulmonary thromboembolism (25%), with common radiological presentation of diffuse pulmonary infiltrates (56.3%). Dominant clinical diagnoses in patients with generalized MT were adult respiratory distress syndrome, sepsis, gastrointestinal bleeding and meningoencephalitis. Disseminated MT was often associated with secondary anemia or thrombocytopenia (15.8%) and recent surgery (15.8%). Frequent comorbidities included chronic renal failure and malignancies, whereas MT was a dominant cause of death. CONCLUSION Greater awareness of MT is needed to improve recognition in clinical settings. In particular, MT should be considered in patients with atypical clinical presentation and diffuse pulmonary infiltrates on chest X-ray, particularly if they have chronic renal failure, malignancy, hematological disorders or a history of recent surgery. LIMITATIONS None.
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Affiliation(s)
- Ivana Savic
- Ivana Savic, Faculty of Medicine,, University of Belgrade,, Institute of Pathology, Dr Subotica 1 Belgrade 11000 Serbia, . T: +381 11 3643 409,
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Shah S, Carter-Monroe N, Atta MG. Granulomatous interstitial nephritis. Clin Kidney J 2015; 8:516-23. [PMID: 26413275 PMCID: PMC4581373 DOI: 10.1093/ckj/sfv053] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/10/2015] [Indexed: 01/29/2023] Open
Abstract
Granulomatous interstitial nephritis (GIN) is a rare entity detected in ∼0.5-0.9% of all renal biopsies. GIN has been linked to several antibiotics such as cephalosporins, vancomycin, nitrofurantoin and ciprofloxacin. It is also associated with NSAIDs and granulomatous disorders such as sarcoidosis, tuberculosis, fungal infections, and granulomatosis with polyangiitis. Renal biopsy is critical in establishing this diagnosis, and the extent of tubular atrophy and interstitial fibrosis may aid in determining prognosis. Retrospective data and clinical experience suggest that removal of the offending agent in conjunction with corticosteroid therapy often results in improvement in renal function. We describe a patient with a history of multiple spinal surgeries complicated by wound infection who presented with confusion and rash with subsequent development of acute kidney injury. Urinalysis demonstrated pyuria and eosinophiluria, and renal biopsy revealed acute interstitial nephritis with granulomas. These findings were attributed to doxycycline treatment of his wound infection. This review explores the clinical associations, presentation, diagnosis, and treatment of this uncommon cause of acute kidney injury.
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Patil SB, Desai AS, Biradar AN, Kundargi VS. Extensive nephroureteric calcification presenting with renal failure: A rare case report. Urol Ann 2015; 7:375-7. [PMID: 26229330 PMCID: PMC4518379 DOI: 10.4103/0974-7796.157958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 03/13/2015] [Indexed: 12/02/2022] Open
Abstract
The diagnosis of renal Tuberculosis (TB) can be hypothesized in the setting of non-specific bacterial cystitis associated with a therapeutic failure or a urinalysis with a persistent leukocyturia and absence of bacteriuria. Renal TB is an important cause of kidney disease, mainly in tropical areas of the globe, which can lead to end-stage renal disease if not diagnosed early and treated correctly. We report a case of a 58 year man with a past history of pulmonary TB treated for six months with extensive nephroureteric calcification presenting with renal failure.
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Affiliation(s)
- Siddangouda B Patil
- Department of Urology, BLDEU's Shri B.M. Patil Medical College Hospital and Research Centre, Vijaypur, Karnataka, India
| | - Anup S Desai
- Department of Urology, BLDEU's Shri B.M. Patil Medical College Hospital and Research Centre, Vijaypur, Karnataka, India
| | - Ashok N Biradar
- Department of Urology, BLDEU's Shri B.M. Patil Medical College Hospital and Research Centre, Vijaypur, Karnataka, India
| | - Vinay S Kundargi
- Department of Urology, BLDEU's Shri B.M. Patil Medical College Hospital and Research Centre, Vijaypur, Karnataka, India
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Altiparmak MR, Trabulus S, Balkan II, Yalin SF, Denizli N, Aslan G, Doruk HE, Engin A, Tekin R, Birengel S, Cetin BD, Arslan F, Turhan V, Mert A. Urinary tuberculosis: a cohort of 79 adult cases. Ren Fail 2015; 37:1157-63. [PMID: 26123266 DOI: 10.3109/0886022x.2015.1057460] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We aimed to investigate the demographic, clinical, diagnostic, treatment and outcome features of patients with urinary tuberculosis (UTB). Patients with UTB admitted to seven separate centers across Turkey between 1995 and 2013 were retrospectively evaluated. The diagnosis of UTB was made by the presence of any clinical finding plus positivity of one of the following: (1) acid-fast bacilli (AFB) in urine, (2) isolation of Mycobacterium tuberculosis, (3) polymerase chain reaction (PCR) for M. tuberculosis, (4) histopathological evidence for TB. Seventy-nine patients (49.36% male, mean age 50.1 ± 17.4 years) were included. Mean time between onset of symptoms and clinical diagnosis was 9.7 ± 8.9 months. The most common signs and symptoms were hematuria (79.7%), sterile pyuria (67.1%), dysuria (51.9%), weakness (51.9%), fever (43%) and costovertebral tenderness (38%). Cystoscopy was performed in 59 (74.6%), bladder biopsy in 18 (22.8%), kidney biopsy in 1 (1.26%) and nephrectomy in 12 (15.2%) patients. Histopathological verification of UTB was achieved in 12 (63.1%) patients who undergone biopsy and in 100% of those undergone nephrectomy. Mycobacterium tuberculosis was isolated in the urine of 50 (63.3%) cases. Four-drug standard anti-TB treatment was the preferred regimen for 87.3% of the patients. Mean treatment duration was 10.5 ± 2.7 months. Deterioration of renal function occurred in 15 (18.9%) patients two of whom progressed to end-stage renal disease and received hemodialysis. Only one patient died after 74-day medical treatment period. Cases with UTB may present with non-specific clinical features. All diagnostic studies including radiology, cyctoscopy and histopathology are of great importance to exclude UTB and prevent renal failure.
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Affiliation(s)
- Mehmet Riza Altiparmak
- a Department of Internal Medicine, Division of Nephrology , Cerrahpasa Medical School, Istanbul University , Istanbul , Turkey
| | - Sinan Trabulus
- a Department of Internal Medicine, Division of Nephrology , Cerrahpasa Medical School, Istanbul University , Istanbul , Turkey
| | - Ilker Inanc Balkan
- b Department of Infectious Diseases , Cerrahpasa Medical School, Istanbul University , Istanbul , Turkey
| | - Serkan Feyyaz Yalin
- a Department of Internal Medicine, Division of Nephrology , Cerrahpasa Medical School, Istanbul University , Istanbul , Turkey
| | - Nazim Denizli
- c Department of Internal Medicine, Division of Nephrology , Haydarpasa Training and Research Hospital , Istanbul , Turkey
| | - Gonul Aslan
- d Department of Clinical Microbiology, Medical Faculty , Mersin University , Mersin , Turkey
| | - Hasan Erdal Doruk
- e Department of Urology, Medical Faculty , Mersin University , Mersin , Turkey
| | - Aynur Engin
- f Department of Infectious Diseases, Medical Faculty , Cumhuriyet University , Sivas , Turkey
| | - Recep Tekin
- g Department of Infectious Diseases, Medical Faculty , Dicle University , Diyarbakir , Turkey
| | - Serhat Birengel
- h Department of Infectious Diseases, Medical Faculty , Ankara University , Ankara , Turkey
| | - Birsen Durmaz Cetin
- i Department of Infectious Diseases, Medical Faculty , Koc University , Istanbul , Turkey
| | - Ferhat Arslan
- j Department of Internal Medicine, Division of Infectious Diseases, Medical Faculty , Medipol University , Istanbul , Turkey , and
| | - Vedat Turhan
- k GATA Haydarpasa Training and Research Hospital , Istanbul , Turkey
| | - Ali Mert
- j Department of Internal Medicine, Division of Infectious Diseases, Medical Faculty , Medipol University , Istanbul , Turkey , and
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A 68-year-old woman with recurrent cystitis. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2015; 26:e59-61. [PMID: 26015798 PMCID: PMC4419823 DOI: 10.1155/2015/761829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Shen TC, Huang KY, Chao CH, Wang YC, Muo CH, Wei CC, Tu CY, Hsia TC, Shih CM, Hsu WH, Sung FC, Kao CH. The risk of chronic kidney disease in tuberculosis: a population-based cohort study. QJM 2015; 108:397-403. [PMID: 25352683 DOI: 10.1093/qjmed/hcu220] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The relationship between tuberculosis (TB) and subsequent chronic kidney disease (CKD) remains unclear. Therefore, we examined the risk of CKD among patients with TB in a nationwide study. METHODS We conducted a retrospective cohort study using data from the National Health Insurance system of Taiwan. The cohort included 8735 patients who were newly diagnosed with TB. Patients were recruited between 1998 and 2002, and the date of diagnosis was defined as the index date. Each patient was randomly matched with four people from the general population without TB, according to age, gender and the index year. The occurrence of CKD was followed up until the end of 2011. The relative risks of CKD were estimated using the Cox proportional hazard model after adjusting for age, gender, index year and comorbidities. RESULTS The overall incidence of CKD was 1.27-fold greater in the TB cohort than in the non-TB cohort. The adjusted hazard ratio (HR) of CKD associated with TB was higher in women (1.72; 95% confidence interval [CI]: 1.33-2.22), those aged <50 years (1.67; 95% CI: 1.15-2.41) and those without comorbidities (1.39; 95% CI: 1.06-1.83). In addition, patients with more comorbidities among hypertension, diabetes and hyperlipidemia have a greater risk of developing CKD in both cohorts, and the adjusted HRs were higher in the TB cohort than in the non-TB cohort. CONCLUSION TB patients had a significantly higher risk of developing CKD than the general population. The detailed mechanisms need further investigation.
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Affiliation(s)
- T-C Shen
- From the Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 404, Division of Pulmonary Medicine, Department of Internal Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Management Office for Health Data, China Medical University Hospital, China Medical University, Division of Nephrology, Department of Pediatrics, China Medical University Hospital, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan From the Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 404, Division of Pulmonary Medicine, Department of Internal Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Management Office for Health Data, China Medical University Hospital, China Medical University, Division of Nephrology, Department of Pediatrics, China Medical University Hospital, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan
| | - K-Y Huang
- From the Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 404, Division of Pulmonary Medicine, Department of Internal Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Management Office for Health Data, China Medical University Hospital, China Medical University, Division of Nephrology, Department of Pediatrics, China Medical University Hospital, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan
| | - C-H Chao
- From the Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 404, Division of Pulmonary Medicine, Department of Internal Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Management Office for Health Data, China Medical University Hospital, China Medical University, Division of Nephrology, Department of Pediatrics, China Medical University Hospital, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan
| | - Y-C Wang
- From the Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 404, Division of Pulmonary Medicine, Department of Internal Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Management Office for Health Data, China Medical University Hospital, China Medical University, Division of Nephrology, Department of Pediatrics, China Medical University Hospital, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan
| | - C-H Muo
- From the Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 404, Division of Pulmonary Medicine, Department of Internal Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Management Office for Health Data, China Medical University Hospital, China Medical University, Division of Nephrology, Department of Pediatrics, China Medical University Hospital, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan
| | - C-C Wei
- From the Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 404, Division of Pulmonary Medicine, Department of Internal Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Management Office for Health Data, China Medical University Hospital, China Medical University, Division of Nephrology, Department of Pediatrics, China Medical University Hospital, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan
| | - C-Y Tu
- From the Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 404, Division of Pulmonary Medicine, Department of Internal Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Management Office for Health Data, China Medical University Hospital, China Medical University, Division of Nephrology, Department of Pediatrics, China Medical University Hospital, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan
| | - T-C Hsia
- From the Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 404, Division of Pulmonary Medicine, Department of Internal Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Management Office for Health Data, China Medical University Hospital, China Medical University, Division of Nephrology, Department of Pediatrics, China Medical University Hospital, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan
| | - C-M Shih
- From the Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 404, Division of Pulmonary Medicine, Department of Internal Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Management Office for Health Data, China Medical University Hospital, China Medical University, Division of Nephrology, Department of Pediatrics, China Medical University Hospital, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan
| | - W-H Hsu
- From the Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 404, Division of Pulmonary Medicine, Department of Internal Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Management Office for Health Data, China Medical University Hospital, China Medical University, Division of Nephrology, Department of Pediatrics, China Medical University Hospital, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan
| | - F-C Sung
- From the Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 404, Division of Pulmonary Medicine, Department of Internal Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Management Office for Health Data, China Medical University Hospital, China Medical University, Division of Nephrology, Department of Pediatrics, China Medical University Hospital, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan
| | - C-H Kao
- From the Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 404, Division of Pulmonary Medicine, Department of Internal Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Management Office for Health Data, China Medical University Hospital, China Medical University, Division of Nephrology, Department of Pediatrics, China Medical University Hospital, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan From the Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 404, Division of Pulmonary Medicine, Department of Internal Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Management Office for Health Data, China Medical University Hospital, China Medical University, Division of Nephrology, Department of Pediatrics, China Medical University Hospital, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan
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Yamada S, Ueki K, Kawai Y, Sako T, Shimomura Y, Tsuchimoto A, Tanaka S, Matsui R, Maeda H, Tokumoto M, Ooboshi H, Kitazono T, Tsuruya K. Extrapulmonary tuberculosis presented as fever of unknown origin in two patients with endstage kidney disease not on dialysis: usefulness of 18-FDG-PET/CT in the diagnostic localization of fever of unknown origin. CEN Case Rep 2015; 5:11-17. [PMID: 28509157 DOI: 10.1007/s13730-015-0181-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 04/06/2015] [Indexed: 11/30/2022] Open
Abstract
Tuberculosis is one of the common causes of fever of unknown origin in patients with chronic kidney disease (CKD). Extrapulmonary tuberculosis is more common in CKD patients, and is, unfortunately, often underdiagnosed despite extensive assessments. Recently, fluorine-18-deoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) has been available in the diagnosis of malignancy, inflammatory and infectious diseases, and has become a useful diagnostic tool. Here, we present two cases of endstage kidney disease who presented with fever of unknown origin at the time of dialysis initiation. In both cases, although interferon-gamma-releasing assay was positive, combined conventional diagnostic modalities such as computed tomography and gallium-citrate scintigraphy failed to detect the sites infected with tuberculosis. By contrast, extrapulmonary lesions were detected by FDG-PET/CT and successfully treated with combined anti-tuberculous drugs. Diagnosis of extrapulmonary tuberculosis was confirmed by biopsy of the affected lymph node and lumbar spine, followed by PCR of the biopsied specimen. These cases highlight the importance of considering tuberculosis as one of the differential diagnoses in pre-dialysis CKD patients with persistent fever, and the usefulness of FDG-PET/CT in the detection of infectious sites of extrapulmonary tuberculosis.
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Affiliation(s)
- Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Kenji Ueki
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhiro Kawai
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Teppei Sako
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yukiko Shimomura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akihiro Tsuchimoto
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigeru Tanaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Rei Matsui
- Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Hiroto Maeda
- Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Masanori Tokumoto
- Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Hiroaki Ooboshi
- Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuhiko Tsuruya
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. .,Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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[Fanconi syndrome in a 22-year-old African patient]. Nephrol Ther 2014; 10:471-4. [PMID: 25439108 DOI: 10.1016/j.nephro.2014.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 05/12/2014] [Accepted: 06/06/2014] [Indexed: 11/20/2022]
Abstract
Acquired Fanconi syndrome can occur in patients with monoclonal gammopathy or after exposure to heavy metals or drug agents such as ifosfamide, and some antiretroviral therapies. Fanconi syndrome is characterized by a dysfunctional of the proximal tubular responsible in its complete form for polyuria, hypokalemia, glycosuria, hypophosphatemia and low molecular weight proteinuria. We report the case of a 22-year-old patient hospitalized with an acute renal failure secondary to a tubulo-interstitial nephritis associated with a complete Fanconi syndrome in a context of a poor general condition and fever. We described and analyzed the process leading to the diagnosis.
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Caliskan B, Yazici H, Gulluoglu M, Caliskan Y, Turkmen A, Sever MS. Renal transplantation in a patient with chronic granulomatous disease: case report. Transplant Proc 2014; 47:158-60. [PMID: 25480525 DOI: 10.1016/j.transproceed.2014.07.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 07/15/2014] [Indexed: 01/04/2023]
Abstract
Chronic granulomatous disease (CGD) is a genetic disease caused by structural mutations in the enzyme NADPH oxidase that results in severe immunodeficiency. End-stage renal disease occurs in this patient population and is attributed to various factors, including infections, amyloidosis, and nephrotoxic anti-infective agents. In this report, we present our experience in transplantation for a patient with CGD complicated by isolated hepatic tuberculosis abscess. The course of the case demonstrates the absolute requirements for a multidisciplinary and compulsive approach before, during, and after transplantation. This case report also highlights the unexpectedly benign effects of immunosuppressive therapy in this patient population.
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Affiliation(s)
- B Caliskan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Istanbul University, Istanbul, Turkey.
| | - H Yazici
- Division of Nephrology, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - M Gulluoglu
- Department of Pathology, Istanbul University, Istanbul, Turkey
| | - Y Caliskan
- Division of Nephrology, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - A Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - M S Sever
- Division of Nephrology, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
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Shenoy V, Chakradhar V, Munim F, Mukhopadhyay C. An Integrated Approach Using Liquid Culture System Can it Make an Impact for Clinical Diagnosis of Genitourinary Tuberculosis? Ann Med Health Sci Res 2014; 4:S144-6. [PMID: 25184082 PMCID: PMC4145512 DOI: 10.4103/2141-9248.138037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Tuberculosis (TB) is one of the major health problems in India. Genitourinary TB (GUTB) comprises 20% of all extrapulmonary TB, and is the most common extrapulmonary site to be affected by this disease. The spectrum of varied pathological changes occur in GUTB, hence a thorough knowledge is required to prevent complications related to GUTB. Diagnostic dilemma is a common problem faced as culture and polymerase chain reaction results vary in their sensitivity and specificity. A thorough knowledge of epidemiology, immunopathogenesis, and spectrum of the disease and importance of including liquid culture system for the diagnosis of this disease are presented in three cases.
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Affiliation(s)
- Vp Shenoy
- Department of Microbiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - V Chakradhar
- Department of Microbiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - F Munim
- Department of Microbiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - C Mukhopadhyay
- Department of Microbiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Abstract
We provide an overview of assessment of the kidneys at autopsy, with special considerations for pediatric versus adult kidneys. We describe the approach to gross examination, tissue allocation when needed for additional studies of potential medical renal disease, the spectrum of congenital abnormalities of the kidneys and urinary tract, and approach to cystic diseases of the kidney. We also discuss common lesions seen at autopsy, including acute tubular injury, ischemic versus toxic contributions to this injury, interstitial nephritis, and common vascular diseases. Infections commonly involve the kidney at autopsy, and the key features and differential diagnoses are also discussed.
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Affiliation(s)
- Paisit Paueksakon
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, MCN C3310, 1161 21st Avenue South, Nashville, TN 37232-2561, USA.
| | - Agnes B Fogo
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, MCN C3310, 1161 21st Avenue South, Nashville, TN 37232-2561, USA
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