[Evaluation of clinical presentation and prognosis of tuberculosis in patients undergoing hemodialysis].

INTRODUCTION Patients with chronic renal failure treated with hemodialysis represent a high risk group for the development of tuberculosis (TB) in comparison to general population. AIM The aim of the study was to evaluate clinical presentation, biochemical parameters and outcome of tuberculosis in patients attending the Center for Hemodialysis, Sarajevo University Clinical Center. PATIENTS AND METHODS The study conducted during the 2000-2005 period included four patients with tuberculosis that were already treated with chronic hemodialysis. Three of these four patients had pulmonary type and one had extrapulmonary type (bone type) of tuberculosis diagnosed by bone biopsy. Miliary TB diagnosis was verified with radiographic lung imaging and appropriate bacteriologic and biochemistry tests. RESULTS The mean age of the study patients was 66.5 +/- 59.6 years and mean hemodialysis duration 6.7 +/- 4.5 years. During the study period, we diagnosed four cases of active tuberculosis in 200 patients receiving hemodialysis therapy (2%). Tuberculin test was performed in all four patients and was negative. Clinical presentation was predominated by inappetence, feebleness and elevated body temperature. Biochemical tests revealed anemia (Htc 0.25 +/- 0.15), hypoalbuminemia (36.0 +/- 28.5) and extremely raised sedimentation raste (86 +/- 30). Increased transaminases were present in two of four patients; the culture of Mycobacterium tuberculosis was found in patients with pulmonary type of TB. Radiographic tests revealed miliary changes in two patients and pleural effusion in one patient. All patients were administered tuberculostatic drugs and six-month treatment resulted in full recovery. CONCLUSION Negative PPD test does not exclude the occurrence of TB in hemodialysis patients and the existence of pulmonary infiltrate and pleural effusion on radiographic chest images suggests the presence of the TB.