Detection of Acid-Fast Bacillus, Interstitial Granulomatous Inflammation, and Infection-Associated Glomerulonephritis in a Patient With Tuberculosis
- Glomerular Diseases: Clinical, Outcomes, Trials - II
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials
- Gerardine, Supriya, Memorial Sloan Kettering Cancer Center, New York, New York, United States
- Gutgarts, Victoria, Memorial Sloan Kettering Cancer Center, New York, New York, United States
- Salvatore, Steven, Weill Cornell Medicine, New York, New York, United States
- Shaikh, Aisha, Memorial Sloan Kettering Cancer Center, New York, New York, United States
Mycobacterium tuberculosis (TB) can affect the urinary collecting system and the kidney. Direct renal TB infection can cause glomerulonephritis (GN) and interstitial granulomatous nephritis. Extra-renal TB infection can lead to infection-associated GN. We report a case of infection-associated GN, interstitial granulomatous inflammation, and the presence of acid-fact bacillus in the kidney in a patient with disseminated TB.
A 70-year-old man with laryngeal cancer presented to the hospital with fever, cough, and blood-tinged secretions from the tracheostomy. He had acute kidney injury (creatinine 1.7 mg/dL), hematuria, pyuria, and severe proteinuria (UPCR 8 g/g). Blood and urine cultures showed no growth. CT chest revealed small bilateral nodules consistent with miliary TB, and bronchial secretions grew mycobacterial TB. Kidney biopsy showed IgA-dominant immune complex GN with sub-epithelial hump-shaped deposits suggestive of infection-associated GN. The kidney biopsy also showed an interstitial non-caseating granuloma with an acid-fast bacillus (Image). Anti-tuberculosis therapy was initiated for disseminated TB infection involving the lungs and kidneys.
This report describes a rare case of infection-associated GN and interstitial granulomatous inflammation due to disseminated TB. The presence of acid-fast bacillus in the kidney suggests renal TB infection. The combination of isoniazid, rifampin, pyrazinamide, and ethambutol is used to treat disseminated TB. A favorable response to anti-tuberculosis therapy in TB-associated infectious GN has been reported, but such findings are limited to a small number of cases. Knowledge of the renal manifestations of TB infection can lead to early diagnosis and timely initiation of anti-tuberculosis therapy.
Kidney biopsy findings. A. Proliferative GN, B. Non-caseating granuloma, C. Acid-fast bacillus