Dr Siti Nur Rohmah1, Dr IRI KUSWADI1, Dr HERU PRASANTO1, Dr METALIA PUSPITASARI1, Dr YULIA WARDHANI1
1Nephrology and Hypertension Division, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada / Dr. Sardjito General Hospital, Yogyakarta, Indonesia
Background: Tuberculosis (TB) is one of the most severe bacterial infections after kidney transplantation and is the leading health problem in developing tropical countries. Anti-tuberculosis treatment (ATT) has side effects and frequent drug interactions with immunosuppressant drugs.
Case Report: We present two cases of active TB in kidney transplant recipients with different clinical presentations and outcomes. Case 1: A 42-year-old man with end-stage kidney disease (ESKD) caused by hypertension had comorbid heart failure, an unrelated living donor, and a history of acute rejection two weeks post-transplantation. He was diagnosed with disseminated TB one-year post-transplantation. The three-month post-ATT found that tacrolimus level decreased and serum creatinine increased drastically, so the immunosuppressant dose was adjusted. However, allograft kidney failure occurred in the fourth-month post-ATT, and the patient underwent hemodialysis. Case 2: A 31-year-old female with ESKD caused by hypertension had comorbid tertiary hyperthyroidism, an unrelated living donor, and a history of delayed graft function. She was diagnosed with pulmonary TB at one-year post-transplantation. The three-month post-ATT found that tacrolimus level decreased drastically, but stable allograft kidney function was found until completion of ATT.
Conclusions: The diagnosis and management of TB after kidney transplantation are challenging, especially with atypical symptoms and variable clinical outcomes. Significant interactions between ATT and tacrolimus can occur at the beginning of three months of ATT, so drug adjustments with frequent and close monitoring are needed. TB prophylaxis in kidney transplant recipients is essential within one year after transplantation, especially in endemic countries.
Keywords: Kidney Transplantation, Tuberculosis, Allograft Kidney Function
Biography:
Siti Nur Rohmah is a Fellow student of Nephrology and Hypertension Division, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada / Dr. Sardjito General Hospital, Yogyakarta, Indonesia. She is interested in kidney transplantation, glomerular disease, and interventional nephrology.