Tuberculous peritonitis in patients on chronic peritoneal dialysis: case reports.

Two cases of tuberculous (TB) peritonitis on chronic peritoneal dialysis (PD) are described. The cases were diagnosed by positive acid fast bacilli (AFB) culture from the PD fluid effluent. Catheter removal and transfer to hemodialysis were needed in one, while the other remained on continuous ambulatory peritoneal dialysis. The patients recovered with antituberculous therapy. A high index of suspicion for early diagnosis and treatment is emphasized. A six-month course of anti-TB drugs for TB peritonitis is a viable option of therapy.

Spectrum of tuberculosis in dialysis patients in saudi arabia.

Data from different regional hospitals of Saudi Arabia were collected to know the prevalence, clinical features and results of therapy of tuberculosis, in patients on dialysis. Eight hospitals located in five different provinces of Saudi Arabia were involved. There were 132 patients with TB on dialysis of whom 75 were males (mean ages in different hospitals ranging 42-58 years) and 57 were females (mean ages ranging 38-58 years). The prevalence of TB in these patients varied from 2.4 to 14.5% with an average of 7%, which is 12 times commoner than in the general population of Saudi Arabia. The presenting clinical features were fever (65%), cough (17%), weight loss (59%) and anorexia (58%). The organs/systems involved by TB were pulmonary in 73 (55.3%), lymphadenopathy in 30 (22.7%) peritoneal in 27 (20.4%) and bone in seven (5.3%). The diagnosis of TB was made by X-ray chest in 73, positive acid fast bacilli in sputum in 38, lymph node biopsy in 30, ascitic fluid examination in 20 and other tests in 17 patients. Four anti-TB drugs namely, isoniazid (INH), rifampicin (Rif), ethambutol (Eth) and pyrazinamide (Pyra) were used in 58 patients (44%) for six months; three drugs namely, INH, Rif, and Eth or Pyra were used in 61 patients (46%) for a variable period of six to 12 months. A total of 28 (21%) patients expired, eight while on therapy, one before starting the therapy and 19 after they were cured of TB. The main causes of death were sepsis in eight (28.5%), cardiovascular in seven (25%) and sudden death in six (21%). TB was not the direct cause of death in any of the patients except one, in whom it could be contributory.

Repeated pregnancies in patients with primary membranous glomerulonephritis.

This retrospective study was carried out in patients with membranous glomerulonephritis (MGN) and repeated pregnancies, the aim being to see how one influences the other. Patients with two or more pregnancies after MGN were included in the study. Nine patients underwent 51 pregnancies (range 2-12, mean 5.6) and 30 were post-MGN (range 2-5, mean 3.2). Their ages were 27-44 (32 +/- 5.7) years. The duration of follow-up was 2-10 (5.6 +/- 2.5) years. The pregnancy outcome, i.e., number of full-term deliveries (FT), spontaneous abortion, preterm deliveries (PT), perinatal mortality (PM), low-birth-weight babies (LBW) and cesarean section (CS), was noted. In the pre-MGN group (n = 21), there were 20 (95.2%) live births and 1 (4.7%) abortion; none had PT, PM, LBW or CS. In the post-MGN group (n = 30), there were 27 (90%) live births, 2 (6.6%) PT, 1 (3.3%) abortion, 1 (3.3%) PM, 3 (10.0%) LBW babies and 3 (10.3%) CS. However, in comparison, there was no statistically significant difference in the pregnancy outcome between the two groups (p > 0.05 in all). Comparing the incidence of hypertension, proteinuria and serum creatinine levels between the first and the last post-MGN pregnancies, there was no statistically significant difference between the two groups. Only 1 patient developed renal insufficiency (serum creatinine 220 micromol/l) after undergoing 5 pregnancies and follow-up of 6 years. In conclusion, the outcome of repeated pregnancies in patients with MGN is good with 90% live births. Repeated pregnancies do not influence the course of MGN.