Mycobacteria-Induced Chronic Kidney Disease

Mycobacterium tuberculosis
Tuberculosis (or TB) is an infectious disease usually caused by Mycobacterium tuberculosis bacteria. In South-East Asia and Western Pacific Regions, tuberculosis (or TB) is still a major public health issue and is expected to pose greater challenges with emergence of multi-drug resistance.

Spread of the mycobacterium to the kidney with a gradual, asymptomatic progression of the disease leads to delay in diagnosis. Involvement of urinary bladder and ureters leads to obstructive nephropathy. Extensive destructive caseous lesions, ulceration and dystrophic calcification involving renal parenchyma lead to CKD[1].

Involvement of the kidneys can also present as granulomatous interstitial nephritis that may be difficult to distinguish from sarcoidosis[2]. TB is the commonest cause of secondary amyloidosis in the Indian subcontinent[3]. Diagnosis of renal TB is usually unsatisfactory due to poor culture techniques, and poor sensitivity of nucleic acid based tests. In late disease, even with effective anti-tubercular drugs renal injury persists and leads to CKD[4].

Mycobacterium leprae
Leprosy caused by Mycobacterium leprae is another important mycobacterial infection of public health problem, which also involves the kidney. Despite reduction in its prevalence, leprosy remains endemic in many parts of the world particularly south Asia[5].

In a report of 122 cases from India, reduced creatinine clearance, and proteinuria were common. Autopsy studies revealed a wide spectrum of renal lesions, including renal amyloidosis, glomerulonephritis, tubulointerstitial nephritis and granulomatous disease[6].

We propose to call this Chronic Kidney Disease of non-Traditional causes (CKDnT): Mycobacteria-Induced Chronic Kidney Disease.

[1] Yadav et al: Genital tuberculosis: current status of diagnosis and management in Tranlational Andrology and Urology – 2016. See here.
[2] Oliveira et al: Single-centre experience of granulomatous interstitial nephritis—time for a new approach? in Clinical Kidney Journal – 2017. See here.
[3] Chugh et al: Pattern of renal amyloidosis in Indian patients in Postgraduate Medical Journal – 1981. See here.
[4] Lenk et al: Genitourinary tuberculosis in Current Opinion in Urology. – 2001
[5] Smith et al: The missing millions: a threat to the elimination of leprosy in PloS Neglected Tropical Diseases – 2015 See here.
[6] Silva et al: Leprosy nephropathy: a review of clinical and histopathological features in Revista do Instituto de Medicina Tropical de São Paulo. – 2015. See here.