Abstract：
BACKGROUND: Chronic kidney disease (CKD) patients are at a high risk of tuberculosis (TB), with a relative risk of developing active TB of 10%-25%. Similarly, glomerular disease increases the risk of TB due to diminished glomerular filtration rate, proteinuria, and immunosuppression use. Further, the first-line anti-TB drugs are associated with acute kidney injury (AKI) even in patients with normal kidney functions.
METHODS: We retrospectively identified 10 patients hospitalized with unusual adverse effects of antituberculosis therapy (ATT) from 2013 to 2022.
RESULTS: We found three cases of AKI caused by rifampicin: acute interstitial nephritis, crescentic glomerulonephritis, and heme pigment-induced acute tubular necrosis. We observed rifampicin-induced accelerated hypertension and thrombocytopenia in two patients on maintenance hemodialysis. Isoniazid caused pancreatitis and cerebellitis in two CKD patients, respectively. In a CKD patient, we detected acute gout secondary to pyrazinamide-induced reduced uric acid excretion. We also observed cases of drug rash with eosinophilia and systemic symptoms and hypercalcemia due to immune reconstitution inflammatory syndrome in patients with glomerular disease on ATT. Immediate discontinuation of the offending drug, along with specific and supportive management, led to a recovery in all cases.
CONCLUSIONS: The adverse effects of ATT may be unusually severe and varied in kidney patients due to decreased renal elimination. Early recognition of these adverse effects and timely discontinuation of the offending drug is essential to limit morbidity and mortality.
METHODS: We retrospectively identified 10 patients hospitalized with unusual adverse effects of antituberculosis therapy (ATT) from 2013 to 2022.
RESULTS: We found three cases of AKI caused by rifampicin: acute interstitial nephritis, crescentic glomerulonephritis, and heme pigment-induced acute tubular necrosis. We observed rifampicin-induced accelerated hypertension and thrombocytopenia in two patients on maintenance hemodialysis. Isoniazid caused pancreatitis and cerebellitis in two CKD patients, respectively. In a CKD patient, we detected acute gout secondary to pyrazinamide-induced reduced uric acid excretion. We also observed cases of drug rash with eosinophilia and systemic symptoms and hypercalcemia due to immune reconstitution inflammatory syndrome in patients with glomerular disease on ATT. Immediate discontinuation of the offending drug, along with specific and supportive management, led to a recovery in all cases.
CONCLUSIONS: The adverse effects of ATT may be unusually severe and varied in kidney patients due to decreased renal elimination. Early recognition of these adverse effects and timely discontinuation of the offending drug is essential to limit morbidity and mortality.
摘要：
背景：慢性肾脏病（CKD）患者患结核病（TB）的风险很高，发生活动性结核病的相对风险为10％-25％。同样，由于肾小球滤过率下降，肾小球疾病增加了结核病的风险，蛋白尿,和免疫抑制的使用。Further,即使在肾功能正常的患者中,一线抗结核药物也与急性肾损伤(AKI)相关.
方法：我们回顾性分析了2013年至2022年10例抗结核治疗（ATT）异常不良反应住院患者。
结果：我们发现3例由利福平引起的急性间质性肾炎，新月体肾小球肾炎，血红素色素引起的急性肾小管坏死。我们在两名维持性血液透析患者中观察到利福平引起的加速高血压和血小板减少。异烟肼在两名CKD患者中引起胰腺炎和小脑炎，分别。在CKD患者中，我们检测到急性痛风继发于吡嗪酰胺引起的尿酸排泄减少。我们还观察到ATT肾小球疾病患者因免疫重建炎症综合征引起的嗜酸性粒细胞增多和全身症状以及高钙血症的药疹病例。立即停药，以及具体和支持性的管理，在所有情况下都导致了恢复。
结论：由于肾脏消除减少，在肾脏患者中，ATT的不良反应可能异常严重且各不相同。早期认识到这些不良反应和及时停药对限制发病率和死亡率至关重要。
方法：我们回顾性分析了2013年至2022年10例抗结核治疗（ATT）异常不良反应住院患者。
结果：我们发现3例由利福平引起的急性间质性肾炎，新月体肾小球肾炎，血红素色素引起的急性肾小管坏死。我们在两名维持性血液透析患者中观察到利福平引起的加速高血压和血小板减少。异烟肼在两名CKD患者中引起胰腺炎和小脑炎，分别。在CKD患者中，我们检测到急性痛风继发于吡嗪酰胺引起的尿酸排泄减少。我们还观察到ATT肾小球疾病患者因免疫重建炎症综合征引起的嗜酸性粒细胞增多和全身症状以及高钙血症的药疹病例。立即停药，以及具体和支持性的管理，在所有情况下都导致了恢复。
结论：由于肾脏消除减少，在肾脏患者中，ATT的不良反应可能异常严重且各不相同。早期认识到这些不良反应和及时停药对限制发病率和死亡率至关重要。
