TOPIC DISCUSSION: TB and the Kidney

What is the role of the kidney in Tuberculosis(TB).  A recent paper in KI March 2011 issue deals with this disease entity. The most common finding on the kidney biopsy with TB is Tubular interstitial disease.
A few take home points from the article that is the largest case series of TB associated renal disease.

1. It is still rare to have kidney involvement
2. Kidney involvement is usually late and with chronic TB more than acute TB
3. Most common finding is chronic granulamatous tubular interstitial disease
4. In this series, 9/25 patients became ESRD
5. Treatment includes anti TB regimen +/- steroids as well
6. 36 month follow up of remaining non ESRD patients was dismal as well and worsening CKD
7. Earlier diagnosis and preservation of renal function might be important