Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

1462 Tuberculosis Tubulointerstitial Renal Disease

■Monthly cultures of sputum indicated; if positive beyond 3 months,

consider noncompliance (institute directly observed therapy) or

drug resistance (check sensitivities)

➣Two weeks of therapy with active drugs considered to render

patients no longer infectious

complications and prognosis

■With appropriate therapy, prognosis good and relapse rate <5%

■Chemoprophylaxis indicated for some with positive PPD or positive

whole blood interferon-gamma assay.

■PPD positive if 48–72 hours after intradermal injection, induration

>5 mm present in those with HIV, those receiving immunosuppres-

sive medications, those with close contact with known case of TB and

those with CXRs consistent with TB and not previously treated;≥ 10

mm considered positive in other high risk groups (see risk factors

above); for all others,≥15 mm considered positive

■Those with positive PPD should receive prophylaxis, regardless of

age, if they are HIV positive, are close contacts of known active cases,

are recent converters (defined as increase of 10 mm or more within

2 years) or have predisposing medical conditions; others with posi-

tive PPD treated only if under age 35 years

■Several prophylactic regimens recommended: 9 months of INH,

2 months of RIF plus PZA, or 4 months of RIF

➣Exclude active disease with CXR and cultures (if indicated) before

starting prophylaxis

TUBULOINTERSTITIAL RENAL DISEASE

CHARLES B. CANGRO, MD, PhD and WILLIAM L. HENRICH, MD

history & physical

■There are two forms: acute and chronic

■Acute TIN may present with:

➣asymptomatic increase in BUN and creatinine

➣rapid onset acute renal failure

➣azotemia

➣oliguria (25%-40% of cases)

➣need for dialysis (30% of cases)

➣flank pain (up to 50% of patients) (distention of renal capsule)

➣hypersensitivity rash (maculopapular in 25%-50% of cases)