Tuberkulóza u pacientů s chronickým selháním ledvin

Tuberculosis in End Stage Renal Disease Patients

Background.
In a retrospective study we analysed the incidence of tuberculosis (tb) in end-stage renal diseasepatients undergoing dialysis treatment at the Department of Medicine Strahov, General University Hospital,1st Medical Faculty, Charles University, Prague. Study included patients who died and were autopsied from 1991 till2000.Methods and Results. Active tb was found in 11 cases (4 men and 7 women, age 56 to 84 years) from the total of275 patients, i.e. in 4%. The results confirmed the increased risk of tb in our group as compared to general population.Tuberculosis was diagnosed of in 2 patients before they died and in 3 patients there was a suspicion of tb before thedeath. In 6 cases tb was found during autopsy. Unlike the non-dialysed population, where pulmonary tb has thehighest incidence (in Czech republic 75 %), in the studied group extrapulmonary forms of tb were predominant (9patients, i.e. 81.8 % had some form of extrapulmonary tb). Miliary tb was found in 8 cases (72.7 %). Because thesymptoms of tb are unspecific and they are not pathognomonic, they were masked by other, already known diseasesin patients with multiple co-morbidities. The low number of cases of tb diagnosed before death represents a seriousproblem. Obviously, it is difficult to prove tb unambiguously, even when such possibility is taken into account.Conclusions. In differential diagnosis, we always have to bear in mind the possibility of the patient having tb. Inexamination algorithm we have to concentrate on both pulmonary and extra-pulmonary forms of tb.

Key words:
chronic renal failure, tuberculosis, diagnosis.