Korean J Nephrol.  2003 Jan;22(1):73-79.

Clinical Features of Tuberculosis in Dialysis Patients

• Yoon SY
• Choi SR
• Kang EW
• Goo YS
• Kim BS
• Youn HJ
• Kang SW
• Choi KH
• Lee HY
• Han DS

Abstract

BACKGROUND
A retrospective study of the clinical features of tuberculosis in patients undergoing maintenance dialysis was performed. METHODS: We reviewed medical records of patients. RESULTS: Among thirty-four patients, fourteen were on hemodialysis and twenty were on peritoneal dialysis. Mean age was 52.4 +/- 13.8 years, and interval between initiation of dialysis and onset of tuberculosis ranged from 1 to 146 months. There were 14 cases of pulmonary tuberculosis, 10 cases of tuberculous lymphadenitis, 4 cases of tuberculous peritonitis, 3 cases of miliary tuberculosis, 1 case of spinal tuberculosis, 1 case of tuberculous pericarditis, and 1 case of tuberculosis of thigh. Patients with pulmonary tuberculosis usually presented with dyspnea and malaise. But typical symptoms of tuberculosis such as fever, cough, sputum, and weight loss were rarely observed. Leukocytosis was absent but anemia, hypoalbuminemia and significant increase in acute phase reactants such as ferritin and C-reactive protein was obvious. Diagnosis was established by positive AFB in 3 patients, and in cases of extrapulmonaty tuberculosis, 13 among 20 patients were diagnosed by typical histologic characteristics on a tissue biopsy. Antituberculous treatment consisted of isoniazid, rifampicin, pyrazinamide, and occasionally ethambutol. And in several cases, incision and drainage, pericardiocentesis, or removal of peritoneal catheter were performed. Among the patients, just one recurrence was observed and four patients died while on antituberculous treatment. CONCLUSION: In dialysis patients, extrapulmonary tuberculosis is common and diagnosis of tuberculosis is difficult for its atypical manifestations. Therefore, early diagnosis and prompt initiation of treatment is needed in patients with high suspicion of tuberculosis.

Keyword

Hemodialysis; Peritoneal dialysis; Tuberculosis

MeSH Terms

Acute-Phase Proteins
Anemia
Biopsy
C-Reactive Protein
Catheters
Cough
Diagnosis
Dialysis*
Drainage
Dyspnea
Early Diagnosis
Ethambutol
Ferritins
Fever
Humans
Hypoalbuminemia
Isoniazid
Leukocytosis
Medical Records
Pericardiocentesis
Pericarditis, Tuberculous
Peritoneal Dialysis
Peritonitis, Tuberculous
Pyrazinamide
Recurrence
Renal Dialysis
Retrospective Studies
Rifampin
Sputum
Thigh
Tuberculosis*
Tuberculosis, Lymph Node
Tuberculosis, Miliary
Tuberculosis, Pulmonary
Tuberculosis, Spinal
Weight Loss
Acute-Phase Proteins
C-Reactive Protein
Ethambutol
Ferritins
Isoniazid
Pyrazinamide
Rifampin