Crescentic Glomerulonephritis Associated with Pulmonary Tuberculosis

Abstract

Tuberculosis of kidney and urinary tract is caused by members of the Mycobacterium tuberculosis complex. Kidney is usually infected by haematogenous spread of bacilli from focus of infection in the lungs. Glomerular involvement in tuberculosis presenting as a rapidly progressive glomerulonephritis is a rare entity. We report a rare case of crescentic glomerulonephritis associated with pulmonary tuberculosis in a 26-year-old man. Patient was treated with corticosteroids, haemodialysis, intravenous immunoglobulin and four cycles of plasmapheresis. He did not respond to 4-drug anti-tuberculosis treatment for renal pathology and was switched over to maintenance haemodialysis. However, he responded to pulmonary TB.

Keywords: Acid-resistant bacilli; Anti-tuberculous drug; Immunofluorescence.

[Table/Fig-1]:

Chest radiograph revealing homogenous opacities in both lungs

[Table/Fig-2]:

Photomicrograph of renal biopsy revealing glomeruli with well-developed circumferential cellular crescents compressing or pushing the capillary tufts towards the centres/ vascular poles. Capillary membranes were thickened/wrinkled/duplicated (JSM, X400)

[Table/Fig-3]:

Immunofluorescence studies showing linear fluorescence (+ 2/+3) across 80% to 90% of glomerular capillary walls on staining with anti-human IgG antiserum (IgG X400)