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Tuberculosis in renal transplant patients: The experience of a single center in Medellín-Colombia, 2005-2013 / Tuberculose em pacientes transplantados renais: experiência de um único centro em Medellín-Colômbia, 2005-2013
Higuita, Lina Maria Serna; Nieto-Ríos, John Fredy; Daguer-Gonzalez, Salomon; Ocampo-Kohn, Catalina; Aristizabal-Alzate, Arbey; Velez-Echeverri, Catalina; Vanegas-Ruiz, Juan Jose; Ramirez-Sanchez, Isabel; Tobon, Jhon Jairo Zuleta; Zuluaga-Valencia, Gustavo Adolfo.
  • Higuita, Lina Maria Serna; Pablo Tobón Uribe Hospital.
  • Nieto-Ríos, John Fredy; Pablo Tobón Uribe Hospital.
  • Daguer-Gonzalez, Salomon; Pablo Tobón Uribe Hospital.
  • Ocampo-Kohn, Catalina; Pablo Tobón Uribe Hospital.
  • Aristizabal-Alzate, Arbey; Pablo Tobón Uribe Hospital.
  • Velez-Echeverri, Catalina; Pablo Tobón Uribe Hospital.
  • Vanegas-Ruiz, Juan Jose; Pablo Tobón Uribe Hospital.
  • Ramirez-Sanchez, Isabel; Pablo Tobón Uribe Hospital.
  • Tobon, Jhon Jairo Zuleta; Pablo Tobón Uribe Hospital.
  • Zuluaga-Valencia, Gustavo Adolfo; Pablo Tobón Uribe Hospital.
J. bras. nefrol ; 36(4): 512-518, Oct-Dec/2014. tab
Article in English | LILACS | ID: lil-731151
ABSTRACT

Introduction:

Tuberculosis is a common opportunistic infection in renal transplant patients.

Objective:

To obtain a clinical and laboratory description of transplant patients diagnosed with tuberculosis and their response to treatment during a period ranging from 2005 to 2013 at the Pablo Tobón Uribe Hospital.

Methods:

Retrospective and descriptive study.

Results:

In 641 renal transplants, tuberculosis was confirmed in 12 cases. Of these, 25% had a history of acute rejection, and 50% had creatinine levels greater than 1.5 mg/dl prior to infection. The disease typically presented as pulmonary (50%) and disseminated (33.3%). The first phase of treatment consisted of 3 months of HZRE (isoniazid, pyrazinamide, rifampicin and ethambutol) in 75% of the cases and HZME (isoniazid, pyrazinamide, moxifloxacin and ethambutol) in 25% of the cases. During the second phase of the treatment, 75% of the cases received isoniazid and rifampicin, and 25% of the cases received isoniazid and ethambutol. The length of treatment varied between 6 and 18 months. In 41.7% of patients, hepatotoxicity was associated with the beginning of anti-tuberculosis therapy. During a year-long follow-up, renal function remained stable, and the mortality rate was 16.7%.

Conclusion:

Tuberculosis in the renal transplant population studied caused diverse nonspecific symptoms. Pulmonary and disseminated tuberculosis were the most frequent forms and required prolonged treatment. Antituberculosis medications had a high toxicity and mortality. This infection must be considered when patients present with a febrile syndrome of unknown origin, especially during the first year after renal transplant. .
RESUMO

Introdução:

A tuberculose é uma infecção oportunista comum em pacientes transplantados renais.

Objetivo:

Oferecer uma descrição clínica e laboratorial de pacientes transplantados com diagnóstico de tuberculose e sua resposta ao tratamento durante o período entre 2005 e 2013 no Hospital Pablo Tobón Uribe.

Métodos:

Estudo retrospectivo descritivo.

Resultados:

Em 641 transplantes renais, a tuberculose foi confirmada em 12 pacientes. Destes, 25% tinham histórico de rejeição aguda e 50% apresentaram níveis de creatinina superiores a 1,5 mg/dl antes da infecção. A patologia geralmente se apresentava como pulmonar (50%) e disseminada (33,3%). A primeira fase do tratamento consistiu de três meses de HZRE (isoniazida, pirazinamida, rifampicina e etambutol) em 75% dos casos e HZME (isoniazida, pirazinamida, moxifloxacina e etambutol) em 25% dos pacientes. Durante a segunda fase do tratamento, 75% dos pacientes receberam isoniazida e rifampicina e 25% isoniazida e etambutol. A duração do tratamento variou entre seis e 18 meses. Em 41,7% dos pacientes, hepatotoxicidade foi associada ao início do tratamento da tuberculose. Durante o seguimento de um ano a função renal manteve-se estável e a taxa de mortalidade foi de 16,7%.

Conclusão:

A tuberculose foi responsável por diversos sintomas inespecíficos na população de transplantados renais estudada. Tuberculose pulmonar e disseminada foram as formas mais frequentes de acometimento e necessitaram de tratamento prolongado. Medicamentos contra a tuberculose apresentaram alta toxicidade e mortalidade. Esta infecção deve ser considerada quando o paciente apresenta síndrome febril de origem desconhecida, especialmente durante o primeiro ano após o transplante renal. .
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Locus Coeruleus / Potassium Channels / Narcotics / Neural Inhibition / Neurons Type of study: Observational study Limits: Animals Country/Region as subject: South America / Colombia Language: English Journal: J. bras. nefrol Journal subject: Nephrology Year: 2014 Type: Article Affiliation country: Colombia

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Full text: Available Index: LILACS (Americas) Main subject: Locus Coeruleus / Potassium Channels / Narcotics / Neural Inhibition / Neurons Type of study: Observational study Limits: Animals Country/Region as subject: South America / Colombia Language: English Journal: J. bras. nefrol Journal subject: Nephrology Year: 2014 Type: Article Affiliation country: Colombia