Diagnostic Problems of Tuberculosis in Patients with End-stage Renal Disease

Tuberculosis in patients with end-stage renal disease is often difficult to diagnose. Due to the absence of sputum or bronchoalveolar aspirate culture, atypical x-ray image and various obscure symptoms, the diagnosis should be confirmed by additional testing. The aim of the study was to evaluate the clinical features of tuberculosis, the diagnostic significance of antibodies ofMycobacterium tuberculosis (MT) and MT DMA in polymerase chain reaction (PCR) in 15 patients with end-stage renal disease (5 hemodialysis patients, 10 kidney graft recipients). Immunosuppression included prednisolone, azatioprin and cyclosporin A combined with ketoconasol. Clinical observations confirmed the atypical course of tuberculosis in most patients. Detection of MT antibodies was highly specific (98,5%), but the method proved not sensitive (50%). The latter can be explained by the impaired formation of antibodies in the presence of immunosuppressive therapy in kidney graft patients, or by immunosuppression due to uremia. MT DNA in PCR appears much more effective for diagnoses of tuberculosis in immunosuppressed patients.

микобактерии туберкулеза, антитела, ДНК, полимеразная цепная реакция, трансплантация почки, диагностика

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