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Submitted: 04 Mar 2024
Accepted: 09 May 2024
ePublished: 24 Jun 2024
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J Nephropharmacol. 2024;13(2): e11679.
doi: 10.34172/npj.2024.11679
  Abstract View: 164
  PDF Download: 60

Case Series

Diagnostic and therapeutic challenges of tuberculosis in kidney transplant recipients; a case series study

Siti Nur Rohmah 1* ORCID logo, Metalia Puspitasari 1 ORCID logo, Yulia Wardhani 1 ORCID logo, Nur Rahmi Ananda 2 ORCID logo, Alfreda Amelia Khotijah 3 ORCID logo

1 Nephrology and Hypertension Division, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing Gadjah Mada University / Dr. Sardjito General Hospital, Yogyakarta, Indonesia
2 Pulmonology Division, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing Gadjah Mada University / Dr. Sardjito General Hospital, Yogyakarta, Indonesia
3 Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing Gadjah Mada University/ Dr. Sardjito General Hospital, Yogyakarta, Indonesia
*Corresponding Author: Siti Nur Rohmah, Email: siti.nur.r@ugm.ac.id

Abstract

Introduction: One of the most serious bacterial infections following kidney transplantation is tuberculosis (TB). Immunosuppressive medications and anti-tuberculosis therapy (ATT) frequently interact with one another and cause adverse effects. This case series focuses on kidney transplant patients who have active TB, with varying clinical manifestations and outcomes.

Case-1: A 42-year-old man with end-stage renal disease (ESRD) underwent a kidney transplant from an unrelated living donor. He was diagnosed with disseminated TB post-transplant. Third-month post-ATT, serum creatinine was increased. His kidney allograft failed and required hemodialysis, but he died.

Case-2: A 31-year-old female with ESRD underwent a kidney transplant from an unrelated living donor. She was diagnosed with pulmonary TB post-transplant. Third-month post-ATT, her tacrolimus decreased significantly; however, her kidney allograft remained stable and still alive.

Case-3: A 29-year-old male with ESRD underwent a kidney transplant from an unrelated living donor. He was diagnosed with pulmonary TB post-transplant. Third-month post-ATT, tacrolimus levels decreased significantly but her kidney allograft remained stable.

Case-4: A 60-year-old man with ESRD underwent a kidney transplant from an unrelated living donor. He was diagnosed with Disseminated TB post-transplant. Third-month post-ATT, tacrolimus levels decreased significantly’ since, her kidney allograft remained stable.

Conclusion: After kidney transplantation, TB might be difficult to diagnose and treat because of its unusual symptoms and varying outcomes. During the first three months of ATT, there may be significant interactions between tacrolimus and ATT. Therefore, frequent and careful monitoring along with medication modifications are required. Tuberculosis prophylaxis is essential for recipients after transplantation, particularly in endemic countries.


Implication for health policy/practice/research/medical education:

Tuberculosis (TB) infection after kidney transplantation with immunosuppressant drugs is still underreported and remains a challenge in both diagnosis and therapy. We present several cases of TB infection after kidney transplantation with unusual symptoms and differing clinical outcome. The existence of interactions between ATT and immunosuppressant treatment requires special attention to avoid kidney allograft failure and rejection. It is important for clinicians and policymakers especially in endemic countries to be aware of these interactions and to take necessary precautions for the diagnosis and management of TB in kidney transplant recipients.

Please cite this paper as: Rohmah SN, Puspitasari M, Wardhani Y, Ananda NR, Khotijah AA. Diagnostic and therapeutic challenges of tuberculosis in kidney transplant recipients; a case series study. J Nephropharmacol. 2024;13(2):e11679. DOI: 10.34172/npj.2024.11679.

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