Pulmonary tuberculosis in patients with chronic renal failure at Zagazig University Hospitals

ABSTRACT

The incidence of active TB and attendant mortality is increased in patients with impaired cellular immunity, such as HIV infected patients, solid organ and stem cell transplant recipients and patients with end-stage renal failure. The relative risk for TB varies with the type of immunodeficiency and mortality rates may be as high as 75%. End-stage renal disease [ESRD] and particularly uraemia is a known contributor to immunosuppression. The aim of this work was to evaluate the increasing risk of pulmonary tuberculosis among patients with chronic renal failure and the impact of hemodialysis. This study was carried at both Nephrology Unit and Chest Department, Zagazig University Hospitals during the period from April 2012 to Jan 2013. The study included a total number of 140 patients with chronic renal failure [92 males and 48 females], with mean age of 49 +/- 6.4 years. Patients were classified to three groups Group 1 Included 40 Patients with chronic renal failure and not on dialysis. Group 2 Included 50 Patients with chronic renal failure and on regular hemodialysis three sittings per week for less than 1 year. Group 3 Included 50 Patients with chronic renal failure and on regular hemodialysis three sittings per week for more than 1 year. All patients were subjected to history taking and medical evaluation including general and local examinations, routine laboratory investigations, Plain chest X-ray; Posteroanterior and lateral views for all patients, Sputum Ziehl-Neelsen staining and Sputum induction in patients who had chest X-ray suspecting pulmonary TB without expectoration and Tuberculin skin testing. Selected cases were subjected to fiberoptic bronchoscopy to obtain BAL for ZN staining 16 patients [11.4%] proved to have pulmonary tuberculosis by + ve ZN stain for acid fast bacilli in either sputum or BAL, 28 patients [20%] were suspected to have pulmonary tuberculosis by radiological suspension and -ve sputum ZN for acid fast bacilli, 6 patients [4.3%] proved to have extra-pulmonary TB while 90 patients [64.3%] were free from tuberculosis. There were no significant differences among different groups as regards infection by TB. Patients with chronic renal failure are at increased risk for pulmonary and extra pulmonary tuberculosis and should be screened routinely and carefully for early detection of TB infection