The Diagnosis of Tuberculosis in Dialysis Patients.
Summary of "The Diagnosis of Tuberculosis in Dialysis Patients."
Tuberculosis is an important issue for nephrologists caring for dialysis patients. Because dialysis patients are immunocompromised, they are at higher risk for reactivation of latent tuberculosis, and they frequently have atypical presentation. Furthermore, hemodialysis units may foster rapid spread of active pulmonary tuberculosis. The diagnosis of active pulmonary tuberculosis still depends on detection of organisms by smear and culture. Newer nucleic acid detection techniques are more sensitive and specific. Nephrologists should remember that nonspecific presentation of tuberculosis including fever, weight loss, and adenopathy are more common in dialysis patients than in the general population, and diagnosis may require biopsy of extrapulmonary tissue. Detection of latent tuberculosis in dialysis patients should only be undertaken if treatment is planned. Generally, this should apply only to potential transplant candidates and younger dialysis patients with longer life expectancy. Tuberculin skin test is very insensitive in dialysis patients, and false-positives occur in patients born in countries where Bacillus Calmette-Guérin vaccine has been used. Blood tests using stimulation of gamma interferon have been shown to be more sensitive tests of latent tuberculosis and may be used in conjunction with tuberculin skin tests.
Affiliation
Division of Nephrology, Department of Medicine, The Toronto General Hospital, Toronto, Ontario, Canada.
Journal Details
This article was published in the following journal.
Name: Seminars in dialysis
ISSN: 1525-139X
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22694662
- DOI: http://dx.doi.org/10.1111/j.1525-139X.2012.01093.x
Medical and Biotech [MESH] Definitions
Renal Dialysis
Therapy for the insufficient cleansing of the BLOOD by the kidneys based on dialysis and including hemodialysis, PERITONEAL DIALYSIS, and HEMODIAFILTRATION.
Tuberculin
A protein extracted from boiled culture of tubercle bacilli (MYCOBACTERIUM TUBERCULOSIS). It is used in the tuberculin skin test (TUBERCULIN TEST) for the diagnosis of tuberculosis infection in asymptomatic persons.
Latent Tuberculosis
The dormant form of TUBERCULOSIS where the person shows no obvious symptoms and no sign of the causative agent (Mycobacterium tuberculosis) in the SPUTUM despite being positive for tuberculosis infection skin test.
Peritoneal Dialysis, Continuous Ambulatory
Portable peritoneal dialysis using the continuous (24 hours a day, 7 days a week) presence of peritoneal dialysis solution in the peritoneal cavity except for periods of drainage and instillation of fresh solution.
Peritoneal Dialysis
Dialysis fluid being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure.
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