Tuberculous interstitial nephritis with progressive chronic renal failure

Genitourinary tuberculosis is one of the most common extrapulmonary forms of tuberculosis, the diagnosis of which is difficult due to the lack of specific symptoms. One of the rare forms of renal tuberculosis is tuberculous interstitial nephritis. Isolated cases of this pathology have been described.

A clinical case of tuberculous interstitial nephritis in a 56-year-old patient is presented. During the diagnostic search, a puncture biopsy of the kidneys was performed, which revealed signs of active granulomatous interstitial nephritis and focal necrotizing glomerulonephritis. Acid-fast mycobacteria were detected in the urine. The patient received anti-tuberculosis chemotherapy (levofloxacin, ethambutol, phenazide, rifampicin, ertapenem), given the decrease in the glomerular filtration rate (GFR) to 3.4 ml/min/1,73м², renal replacement therapy was carried out renal replacement therapy (hemodialysis 4 hours 2 times a week). After 4 months of treatment, an improvement in renal function was noted (GFR 12 ml\min\1,73м²), which required switching to hemodialysis and transferring the patient to the continuation phase of chemotherapy. A repeat kidney biopsy was performed, which revealed chronic granulomatous interstitial nephritis, interstitial fibrosis and grade 3 tubular atrophy.

Conclusion. Timely diagnosis using puncture biopsy of the kidneys and adequate etiotropic therapy can restore kidney function in tuberculous interstitial nephritis.

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